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Editorials |

Chronic Disease Care: Rearranging the Deck Chairs

David M. Lawrence, MD
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From Geyserville, CA 95441.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: David M. Lawrence, MD, PO Box 67, Geyserville, CA 95441; e-mail, David.lawrence@kp.org.


Ann Intern Med. 2005;143(6):458-459. doi:10.7326/0003-4819-143-6-200509200-00010
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The care of patients with chronic disease is one of the most urgent medical challenges in the United States. Chronic illness accounts for most of the demand, expense, and investments in scientific discovery. The well-documented shortcomings in medical quality and safety fall heavily on the shoulders of patients with these conditions (1). Meanwhile, the Medicare program moves steadily toward insolvency (2). Two major trends will seriously aggravate the current situation. Over the next 20 years, demographic changes will drive a substantial increase in the prevalence of chronic diseases. Moreover, scientific advances will greatly expand our ability to diagnose, to treat, and to monitor chronic diseases (3). Our imperative, therefore, is to find models that can reliably and consistently deliver high-value care (highest possible quality and lowest possible cost) for patients with chronic illnesses.

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