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July 1, 1999 Ever wonder what you’ll be doing in five to 10 years? I bet the majority of our readers will be chronic care coaches. Whether you’re a registered nurse, a pharmacist, an occupational therapist, a physical therapist, or a social worker, the bulk of your time will be spent talking with patients and fine-tuning their regimen and resources. Here’s why. Technology is dramatically changing what we’ve long called acute care. Diseases that would have demanded weeks of hospitalization are being nipped in the bud. We’re already seeing examples of this on a number of fronts:
The new century will bring a massive shift in focus in health care, according to a new book by Peter Drucker, Management Challenges for the 21st Century (Harperbusiness, 1999). Drucker says that while we spent most of the 20th century managing disease, we’ll spend the beginning of the 21st century concentrating on life extension, or maximizing the length and quality of life for everyone. And the key to this future is having a work force of nurses and allied health professionals who are educated and skilled in the role of chronic care coach. It’s a step beyond case management because it would involve most patients, not just those with the most complicated cases and conditions. It will involve—at last—a major restructuring of health care. After getting a diagnosis and a treatment plan from a physician, patients will be referred to chronic care coaches to monitor their conditions and educate them as they need more information. Patients with heart failure, for example, may have a coach who’s a nurse. They will check in with their coach twice a week, registering heart rhythm, oxygen saturation, and pulmonary pressures through a computer diagnostic device. The nurse will assess the data and recommend a treatment modification if necessary, such as a minor increase in a diuretic or a reminder about ways to cope with that low-salt diet. A patient recovering from a stroke might have a coach who’s an OT; someone who has just had a hip replacement might be coached by a PT. Whatever their profession, chronic care coaches will contract with managed care organizations to manage groups of patients, and much of the coaching will be done through the phone and by computer-assisted diagnostics. Of course there will still be a work force of acute specialists, working in operating rooms, emergency departments, and ICUs. But the vast majority of others will be employed as these Marcus Welby–like experts who will be able to provide a level of monitoring, education, and encouragement never before available in health care. The work will be interesting and exciting. But the challenge will be to find a way to provide the necessary education and training to develop a work force of chronic care coaches who are truly capable of providing this level of analysis and care. It means putting aside old notions of nursing and health care as being about doing things to patients, and learning better how to monitor and coach, how to talk and teach. What do you think? Barbara
Bronson Gray, MN, RN |