Recommendations
The experience of symptoms is an individual's perception of the frequency, intensity, distress, and meaning as it occurs. Symptoms can be 1 area that affects quality of life but are often multiplicative in nature produced as a byproduct from the failure of 1 or more body systems. Instituting a strong patient-centered program with emphasis on symptom management, patient satisfaction, reduced patient and caregiver stress, and reduced health care costs is an attainable measure. Health care providers will have an additional avenue of consultation available when routine clinic visits fail to produce desired results in terms of improved health status. Management of symptoms through palliative care is congruent with the IOM mandates and the VHA Strategic Plan focusing on patient-centered care, improved health status, and reduced health care costs.
An incidental finding from this project has shown a high incidence of multimorbidity evaluating just 5 chronic disease processes. Sixty-four percent of the veterans enrolled in this study had 2 or more of just 5 chronic disease processes, correlating with the finding from Schneider and associates that 67% of adults have 2 or more of any chronic health condition. New research evaluating multimorbidity and comorbidity as independent and interdependent disease processes that may occur in clusters is essential to evaluate how treatment of 1 symptom may affect another disease process or symptom.
Changing care from an acute model to one focused on the specific needs of each individual patient promotes cost effective, quality care throughout the VHA and into the community. Governmental and private insurance sources can also benefit from outpatient management of chronic disease processes with reduced costs of care from recidivism and improved self-care modalities. Further implications include adding to the knowledge base for chronic illness, outpatient care, palliative care, the patient-centered medical home model of care, interdisciplinary collaboration, home health, and hospice care. Nursing's role in health care reform focusing on patient-centered care from the perspective of bedside caregiver, primary care provider, educator, and organizational leadership is an additional implication for study.