Sick To Death > Chapter 3 > Introduction
Reformers have already tried out some important innovations, including projects showing that patients with serious chronic illness regularly benefit from continuity and coordinated care in which each provider in each setting knows the patient's diagnosis, treatment plan, and preferences. These innovations and reforms are useful not only for what they have achieved for small numbers of people or short periods of time but also for what they can teach about organizing reliable, high-quality care (National Coalition for Health Care and Institute for Healthcare Improvement 2000; Romer et al. 2002; Lynn, Schuster, and Kabcenell 2000). Professional education, health-care provider regulation and certification, and collaborative quality-improvement efforts are making strides toward practical reforms (End of Life/Palliative Education Resource Center 2001; Education for Physicians on End-of-Life Care Project 2000; End- of-Life Nursing Education Consortium 2000; Joint Commission on Accreditation of Healthcare Organizations 2001; Lynn, Schall, et al. 2000; Du Pen et al. 1999). Some programs that began as demonstration models have proven their merit and have become part of routine care: for example, hospice and the Program of All-Inclusive Care for the Elderly (PACE).
Optimal management of the chronically ill or frail elderly requires comprehensive multidimensional assessment of medical, functional, and psychosocial needs; arrangement of community services; coordination across providers; intensive health education and support for lifestyle modification; and methodical tracking of patients' progress between office visits (Chen et al. 2000). A variety of approaches have made some real gains toward ensuring these services. This chapter reviews important insights from these instructive innovations.