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Medicine & Chronic Illness |
PROLOGUE
Medicine And Chronic Illness
PROLOGUE: The "graying" of America has, not surprisingly, been characterized by increasing numbers of people suffering from chronic illnesses and conditions, such as diabetes, heart disease, and Alzheimer’s disease, that impede their ability to function daily. Moreover, the U.S. Administration on Aging (AOA) has estimated that given a current average life expectancy of seventy-five years, a newborn in 2001 can anticipate living with a condition limiting his or her daily activity for upward of thirteen years. Further, because the group age eighty-five and older represents the most rapidly growing segment of the population, activity limitations of twenty years or more may not be uncommon for many Americans.
However, a growing body of evidence suggests that the quality and effectiveness of health service delivery for chronic illnesses have failed to keep pace with dramatic advances in technology and medicine that have yielded, among other things, substantial improvements in longevity. In fact, a report by the Robert Wood Johnson Foundation entitled Chronic Care in America: A Twenty-first Century Challenge asserts that "there is no effective system to care for those with chronic conditions in the United States...[and] much of the care that is available is fragmented, inappropriate, and difficult to obtain."
The papers that follow provide insight into cost-based and systemic factors that have heretofore inhibited realization of qualitative improvements in chronic care. First, Molly Joel Coye explores the link between providers’ persistent inability to use optimal practice patterns and the traditional absence of a business case for quality. Richard Bringewatt, Robert Galvin, and Nancy Oswald provide perspectives on this piece. Next, Edward Wagner and colleagues assess the impact on the quality of chronic care exerted in the transition from our historical acute care framework toward a chronic care model more specifically tailored to the management and delivery of care to the chronically ill.
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