Improving the management of chronic disease

BMJ 2003; 327 doi: (Published 03 July 2003) Cite this as: BMJ 2003;327:12
  1. Richard Smith
  1. BMJ

    The NHS is trying out a new system of caring for people with chronic disease, designed to prevent hospital admission. Professor Robert Kane evaluated an American version of the system

    “In effect, we're practising 19th century medicine in the 21st century,” said Robert Kane, professor in long term care and ageing at the University of Minnesota, with emotion, even anger, when I spoke to him recently. “Most health care is concerned with patients with chronic disease, particularly as they age, and yet we still have a system built around individual care events, like office visits and hospital admissions. The epidemiology is out of synch with the system. We need chronic disease management.”

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    Professor Robert Kane: “Geriatrics is really the intersection of chronic disease management and gerontology

    Why hasn't the system changed? “In the United States,” answers Kane, “health care is 15% of the economy. There are too many vested interests. Doctors are conservative and their teachers are even more conservative. Then there's no consumer demand for change.”

    Kane's interest in improving systems of care began when he did some research in nursing homes in the 1970s, when he was working at the University of Utah. One of his colleagues, the professor of family medicine …

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