Care of Patients with Severe Chronic Illness

The opening paragraph of the executive summary of the 2008 report from the Dartmouth Atlas of Health Care focuses on chronic disease and raises important issues:
"More than 90 million Americans live with at least one chronic illness, and seven out of ten Americans die from chronic disease. The quality of care for Americans with chronic disease is remarkably uneven.Most patients receive episodic care from multiple different physicians who rarely coordinate the care they deliver. And the growing costs of chronic disease care present a threat not only to patients and their families but also to the nation."
Considering that the care of chronic disease is rapidly raising the cost of medical treatment beyond the capability of the nation to sustain it, this publication should be read by everyone. It is clear our training and organizational methods of care need radical revision. We do not provide equitable, appropriate, effective, efficient, affordable care across the couintry. We need to move away from organ based specialty training to developing teams of professionals who can intervene on our behalf before we get to the stage in life described in this report. We need much more focus on primary care.