Meeting the challenge of chronic care

Although chronic care is the predominant mode of illness in developed countries, medical care systems are still organized as if practice addresses acute illness. Major changes are needed in the way medical care is delivered. Emphasis on brief encounters (be they hospital admissions or clinic visits) must transform into a focus on the entire episode of an illness. Patients must become more actively involved in monitoring and attending to their illnesses. Monitoring systems should emphasize specific salient elements of a given chronic disease and compare actual and expected clinical courses. Management should be based on early deviations from the expected course. The roles of both professional and nonprofessional practitioners should be reexamined to look for opportunities for role delegation; teamwork should be used sparingly. The linkage between medical care and long-term care requires shared goals that reflect a concern with slowing the rate of decline in care recipients.