Review
Health Care 2020: Reengineering Health Care Delivery to Combat Chronic Disease

https://doi.org/10.1016/j.amjmed.2014.10.047Get rights and content

Abstract

Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic.

Section snippets

Treatment Options in Chronic Disease

Although chronic disease represents the leading cause of death in the US, 40% of all premature death is due to behaviors amenable to change. Maximizing disease outcomes will therefore require the necessary time and expertise needed for a careful assessment and modification of lifestyle factors.15 In the primary care setting, the median length of a physician visit is <15 minutes, during which a median of 6 topics will be covered, leaving little if any time to formally assess and address the root

Chronic Disease Outcomes and Primary Care Services

Physician adherence to the current evidence base in the management of chronic disease is poor, and patients diagnosed with a chronic disease typically receive only half of the recommended process of care.33, 34 In the case of the 2 most common chronic diseases impacting the population, fewer than 1 in 3 patients with hypertension and hypercholesterolemia attain control of both disorders.34 These gaps in care have been shown subsequently to lead to higher clinical events and added health care

Social Networks

The importance of social network influences on behavior is now well established, having demonstrated considerable impact on smoking, diet, exercise, depression, medication adherence, and obesity.50, 51 Decisions to quit smoking, begin an exercise program, and other health-related behaviors are not made completely by isolated persons, but rather, reflect choices made by groups connected to each other.50 This influence can be extensive, often reaching up to 3 degrees of separation. The fact that

Infrastructure Requirements Going Forward

As health care moves from a volume-to-value strategy, the need to collect and manage data will increase continually, and with it, the necessity to provide analysis, data visualization tools, and education/training surrounding the use of new technologies and the data they generate. Health care systems that develop both discipline and efficiency in data analytics and reporting (as well as the ability to train its staff in the capabilities of these ever-evolving systems) will best manage both

Conclusion

Throughout history, the health care system has reengineered itself continually to meet the medical needs of the time. Isolation wards were created in the late 19th and early 20th centuries to meet the crisis in infectious disease, particularly during the typhoid and influenza epidemics, and mobile army surgical hospitals were crafted in 1945 to better manage surgical emergencies during war. Today, health care must reengineer its care delivery model to manage the chief medical crisis of the 21st

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