The Simple Idea That Is Transforming Health Care

A very simple question is changing the delivery of medical care:

How is your health affecting your quality of life?

For decades, numbers drove the treatment of diseases like asthma, heart disease, diabetes, and arthritis. Public-health officials focused on reducing mortality rates and hitting targets like blood-sugar levels for people with diabetes or cholesterol levels for those with heart disease.

Coming in Tuesday\'s Journal

Big Issues: Health Care


Margaret Riegel
Should all women over 40 get annual mammograms?

Should states opt out of the medicaid expansion?

Should medical residents work shorter shifts?

Join The Experts online starting Tuesday for more on these and other health-care issues.

Doctors, of course, are still monitoring such numbers. But now health-care providers are also adding a whole different, more subjective measure—how people feel about their condition and overall well-being. They\'re pushing for programs where nurses or trained counselors meet with people and ask personal questions like: Is your condition inhibiting your life? Is it making you less happy? Does it make it hard to cope day to day? Then the counselors offer advice about managing those problems and follow up regularly.

The logic is simple. People are more likely to manage their condition properly when they have more accessible, personal goals, like being able to do more at work or keep up with their kids, instead of focusing only on comparatively abstract targets like blood-sugar levels. And that, in turn, leads to much better health. Numerous studies show that when people have a higher sense of well-being, they have fewer hospitalizations and emergency-room visits, miss fewer days of work and use less medication. They\'re also more productive at work and more engaged in the community.

\"Quality of life happens to be the element that is most important in motivating people to deal with an illness,\" says Noreen Clark, director of the Center for Managing Chronic Disease at the University of Michigan. \"People aren\'t motivated to follow their clinical regimen if in fact it doesn\'t improve the way they function and get along with others and manage day to day.\"

Breathing Easier
Focusing on well-being might seem like a basic idea, but it is a departure from the traditional approach to public health, especially when it comes to chronic-disease sufferers. Many get brief checkups with a doctor a few times a year, and there isn\'t time for much beyond getting lab tests, a prescription and some directions to follow. And once patients leave the office, there is little that most doctors can do to make sure they stick to their regimen or help them with any problems or barriers to staying on the wagon.

For an idea of how the new emphasis works, consider Quentonia Ford. Struggling with severe asthma for 25 years, she found it hard to fully understand and manage her medications after brief doctor visits. Often gasping for breath, she had to curtail activities with her husband and family, and sometimes her symptoms got so bad she was hospitalized.

Enlarge Image

Last year, she took part in Women Breathe Free, a program under study at Dr. Clark\'s center at the University of Michigan that aims to improve the well-being of African-American women with asthma.

\"They asked about my quality of life, my family support, whether asthma stopped me from going out and doing the things I liked to do, even how it affected my sex life,\" says Ms. Ford, 63 years old, who works as an administrative assistant for a hospice program. \"No doctor ever asked me questions like that before.\"

Ms. Ford says the program\'s counselors, whom she spoke to over several weeks by phone, provided \"a sounding board\" about many concerns that were bothering her, and helped her understand her medications and how to use them more effectively. In the past, she would wait until her symptoms were severe, hoping things would get better; she now monitors herself more closely by keeping a diary of symptoms and using a device that monitors breathing to let her know if she is entering a danger zone.

Talking to a counselor regularly also helped her overcome fear and depression about her condition, and set reasonable goals for exercise and activity without fearing an asthma attack. In addition, she got the resolve to talk to her family about helping out more with things around the house and recognizing that she couldn\'t do everything they wanted. She has not been hospitalized since she started the program, and last month her doctor told her that her pulmonary-function tests were the best she has had since 2006. She credits the counseling for giving her the tools and is continuing to provide information to the program so they can monitor her progress. \"I never had anyone to talk to who understood me or what I was dealing with,\" Ms. Ford says. \"It has really helped me have more self-confidence and a better outlook about my quality of life.\"