AS THE AVERAGE LIFE SPAN increases and more people develop chronic illnesses, it is becoming apparent that our healthcare system is not providing the necessary combination of coordinated systems to an aging and increasingly complex population. The fact that healthcare costs keep rising without comparable increases in national health outcomes proves this.
Thirty years ago, when life expectancy was shorter and demands on the healthcare system were not as profound, the system delivered care from personal family physicians (physicians working with less complex patients, with more time, and with better relationships with patients and their families). Population growth, better research, better medications, and more intensive interventions created a new period in healthcare history, a period of endless information and incredible patient needs. Fortunately forward-thinking healthcare analysts and researchers have identified gaps in care and developed proposals and theories to bridge the gap. Beginning with the Institute of Medicine's Crossing the Quality Chasm, new ideologies emerged which impugned current practices while identifying primary areas of need (Institute of Medicine 2000).
INTERSECTING MODELS REVOLUTIONIZE HEALTHCARE
In 1992, the American Academy of Pediatrics (AAP) repudiated the current system of care for children with special healthcare needs and published a policy statement defining the medical home (American Academy of Pediatrics 2002). The AAP believes care should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. In 2002, the AAP disseminated an updated policy that refers to a care-delivery system that provides timely access to medical care, improved communication between patients and their healthcare team, coordination and continuity of care, and focus on quality and safety.
The medical home concept aims to improve the entire healthcare delivery system. The medical home idea is a "family-centered" approach, and it stipulates that patients need coordinated and continuous care. In a system that has grown beyond the primary care provider to care from a complex array of providers, coordinated and continuous care has become an absolute necessity.
In 2007, the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA) released "Joint Principles of the PatientCentered Medical Home" (ICIC 2008.) With the support of these organizations the medical home model went beyond an approach to manage children with special needs to become an ideology for improving care for patients across the life span.
In 1998, chronic care innovator Dr. Ed Wagner published the first in a series of precedent-setting articles that evolved into the Chronic Care Model (Wagner 1998). Based on the knowledge that 133 million people live with a chronic condition, a number that is projected to increase by more than 1 percent per year, and that nearly half of those individuals have multiple chronic illnesses, Wagner conceptualized a new, transformative delivery system. This system includes not only an informed patient but an active community, plus health systems that use decision support and clinical information systems such as electronic medical records. Similar to the medical home model, the chronic care model has moved the patient from a place of isolation into a larger family and community support structure, acknowledging that people do not function or live in dissociated states. Further, the chronic care model fosters communication between an involved and educated patient and a proactive, interactive care team. No longer is communication of facts and figures acceptable -communication must involve an exchange of knowledge in a collaborative relationship, what Wagner refers to as "productive interactions." This cooperative model abolishes the hierarchical, archaic structure of physician-patient care and introduces the concept of equal partners using information and decision support to establish unified and achievable goals. …