Chronic Disease and Aging: Two Separate or Related Problems?
Geriatrics represents the intersection of gerontology and chronic disease care. The elderly predominate in chronic disease. Gerontology includes various syndromes and involves managing multiple simultaneous problems across multiple domains (physical, social, economic). Both imply the need to find better ways of delivering care (effectiveness) and to control costs (efficiency). Success in chronic care must be measured in terms of actual versus expected clinical trajectories. Strategies to improve chronic care involve reorganizing care delivery systems.
To promote proactive primary care with improved decision support, more effective disease management and better care coordination (e.g., medical home) are needed. Patient empowerment is central. A critical question is whether there is a business case for better primary care. Can more active care actually achieve subsequent costs savings through reduced resource use? Getting physicians actively involved in primary care will involve removing barriers such fee-for-service payment, which is the anathema of chronic disease care. Dr. Kane supported the creation of incentives (financial, recognition, practice satisfaction) for doing the right thing. Dr. Kane stressed the need for measures that would increase efficiency. For example, we should eliminate scheduled return appointments and instead base revisits on clinical trajectories.