Abstract
Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining—and perhaps improving—high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.
Highlights
The traditional system of medical care is characterized by visits to the clinician who asks about the recent past, examines the patient, makes decisions about therapy, and schedules a follow-up assessment
The traditional system of periodic outpatient assessments relied on fee-for-service, wasted resources when patients were well, underutilized resources when care was needed between clinic visits [7], and prompted some patients or their surrogates to delay seeking care for an adverse event, especially outside the bounds of the regular doctors’/clinic hours [8]
The use of information and communication technologies to deliver healthcare at a distance, supports “patient self-management through remote monitoring and personalised feedback” [86]. These appear to be especially effective for adults with severe chronic diseases, who are at a high-risk of hospitalization and death [86]
Summary
The traditional system of medical care is characterized by visits to the clinician who asks about the recent past, examines the patient, makes decisions about therapy, and schedules a follow-up assessment. We offer a ground-level perspective of clinicians and other care providers who are preparing for the soon-to-be reality of outpatient care of children and adults with chronic diseases This emerging system of care delivery incorporates greater emphasis on self-management (e.g., consuming medications as prescribed, deciding about the need for medical-care or other adjustments), electronic patient-reported outcomes (i.e., symptoms) (ePROs), the “remote surveillance” system that receives these ePROs and electronic data collected by sensors Healthcare 2019, 7, 65 internet enabled scales), assistance navigating service systems, and alerting programs and algorithms that inform the clinical-care team when additional assessment and intervention might be needed [6]. We discuss each of these elements, first individually, and discuss the systems that integrate them
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call