Patients of 21st century require new form of care

By Pat Justis | For The Olympian • Published August 06, 2008

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Almost half of all Americans, 133 million people, live with a chronic health condition. Those 133 million are equally divided among the elderly, working-age adults and children. Care of chronic illness accounts for 75 percent of all U.S. health expenditures. Yet the traditional health care system— designed for short episodes of acute illness— is poorly designed to meet the needs of people with chronic health conditions. The misdirected cry for "market forces" will not solve underlying design flaws.

Americans with chronic health conditions, and aging baby boomers in particular, are surrounded by health care systems that require fundamental redesign. Relevant solutions are emerging in new care models for chronic illness. We have successful examples close to home.

Researchers in the large Dartmouth Atlas Project, with primary funding from Robert Wood Johnson Foundation, can now compare the treatment of Medicare patients with chronic illness across different states, regions, hospitals and physicians. Ongoing study indicates serious problems with quality of care and dramatic variations in practice.

The Dartmouth Atlas Project hopes to end a "more is better myth." In chronic illness care, greater use of medical resources is associated, if anything, with worse outcomes, poorer quality and lower satisfaction with care. More than 30 percent of Medicare dollars are spent on the last two years of life, when available hospital beds become the path of least resistance, and high-tech rescue attempts and aggressive treatments are thrown at illnesses that will not improve, robbing patients of a dignified end of life.

Most people receive episodic care from multiple physicians who may or may not coordinate care. High numbers of patients and informal caregivers lack needed information and are too often excluded from decision making. The medical record is chopped into pieces across multiple providers. Many patients lack a "medical home", a primary care physician who keeps track of the multiple specialists that may be involved in one patient's care. New solutions must carry the seeds of health care prior to the intrusion of technology; a recasting of the family doctor model in which relationships with primary providers extend beyond episodes of care.