Initial Blog: Innovations in Care Delivery

In its 2001 landmark report, the Institute of Medicine wrote, “[Between] the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”1 The purpose of “Innovations in Care Delivery” is to help bridge that chasm for those affected by neurological conditions.

The need for that bridge has never been greater. The poor quality care that the Institute of Medicine described fifteen years ago persists today. As just one example, fifty years after Medicare’s introduction, more than 40% of Medicare beneficiaries with Parkinson disease do not see a neurologist, and those that do not are 20% more likely to fracture a hip, be placed in a skilled nursing facility, and to die.2 The burden of neurological conditions, from autism to Alzheimer disease, is increasing domestically and globally. Chronic conditions, which account for the majority of neurological conditions, are the leading source of death and disability globally3 and account for 85% of US health care expenditures.4

At the same time, the opportunity to improve neurologic care has never been greater. Historically, investment in improving health care delivery has been an afterthought. Of every $100 spent on health care, less than 30 cents is devoted to improving care.5 Private insurers rank last and health systems 19th out of 22 industries in their investment in innovation.5 As a result, health care trailed only construction among 18 industries in productivity gains in the last generation.6 That neglect is beginning to change.

The Patient-Centered Outcomes Research Institute and the Center for Medicare & Medicaid Innovation have devoted substantial funds to developing models to improving the delivery of health care. Venture capital funding in digital health topped $4 billion in 2015, quadruple what was invested just four years earlier.7 As a result of these investments, new models are emerging including palliative care for Parkinson disease, novel rehabilitation models for multiple sclerosis, and use of paramedics to enable older Americans to remain out of hospitals.8

In addition to new funding opportunities, technology is rapidly changing health care delivery. As an example, “telestroke” was introduced as a concept in 2001 as a means for increasing access to a highly effective, time sensitive therapy (tPA).9 In just fifteen years, telestroke has become mainstream,10 and the country’s largest provider of acute stroke care is not a major medical center but a telemedicine company.11 Technology is even shifting remote neurological evaluation from the hospital to the ambulance.12 Increasingly, technology will enable a greater proportion of health care to be delivered at home.13

“Innovations in Care Delivery” will have a decidedly future focus. To do so, the site will highlight new care models from a broad range of disciplines, provide links to a variety of sources on health care innovation, and feature new voices from within and outside of academia. We look forward to your suggestions and feedback on the site and more importantly, on how we can improve care for all with neurological disorders.

References

  1. Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press. 2001
  2. Willis AW, Schootman M, Tran R, et al. Neurologist-associated reduction in PD-related hospitalizations and health care expenditures. Neurology 2012;79:1774-1780.
  3. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013;380:2095-2128.
  4. Anderson G. Chronic Care: Making the Case for Ongoing Care. 2010. Available here. Accessed on January 9, 2016.
  5. Moses H, 3rd, Matheson DH, Cairns-Smith S, George BP, Palisch C, Dorsey ER. The anatomy of medical research: US and international comparisons. JAMA 2015;313:174-189.
  6. Buescher B, Viguerie P. How US healthcare companies can thrive amid disruption: The healthcare industry is undergoing sweeping change. To emerge as winners, incumbents should learn from other industries that have faced similar upheaval. McKinsey & Company. Available here. Accessed January 9, 2016.
  7. Wang T, King E, Perman M, Tecco H. Digital Health Funding: 2015 Year in Review. Rock Health; 2015. Available here. Accessed January 9, 2016.
  8. Center for Medicare & Medicaid Innovation. Health Care Innovation Awards Round Two Project Profiles Available here. Accessed January 9, 2016.
  9. Levine SR, Gorman M. “Telestroke”: the application of telemedicine for stroke. Stroke 1999;30:464-469.
  10. Specialists on Call. Specialists On Call Oversees Its 10,000th tPA Administration to an Acute Stroke Patient [press release]. Business Wire, December 2, 2015. Available here. Accessed January 9, 2016.
  11. David C. Hess & Heinrich J. Audebert. The history and future of telestroke . Nature Reviews Neurology 2013;9:340-350.
  12. Itrat A, Taqui A, Cerejo R, et al. Telemedicine in Prehospital Stroke Evaluation and Thrombolysis: Taking Stroke Treatment to the Doorstep. JAMA Neurol 2015:1-7.
  13. Daschle T, Dorsey ER. The Return of the House Call . Ann Intern Med 2015;162:587-588.

Ray Dorsey, MD

University of Rochester

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