With 50 million Americans approaching retirement age, and chronic health conditions such as diabetes on the rise, the health care industry needs a new delivery model that provides optimal patient care while reducing strain on health care providers. Chronic health conditions require constant monitoring and management, yet the traditional medical delivery system is not geared to provide care for such a large number of patients. The current system, built around periodic office visits to physicians and other medical professionals, is sub-optimal for managing chronic conditions because it leaves long stretches of time during which patients have no contact with their health care providers. This results in inadequate control of disease, more frequent exacerbations that inevitably lead to emergency department visits and unplanned hospitalizations, and poor support for patient self-care.

The Medical Information Systems Unit (MISU) at Boston Medical Center (BMC) has developed an automated phone-based information system designed to monitor the health of patients with chronic health conditions, detect important clinical problems, alert their physicians and help patients take better care of themselves. The system, called TLC (which stands for Telephone Linked Care), regularly calls patients with chronic diseases and asks them to report on their condition, receives directions on modifying their care, and communicates directly with their health care provider if there is a significant change in their condition. The phone-based TLC service provides a weekly, daily or even hourly link between patients and medical professionals, using sophisticated interactive voice response (IVR) technology to direct patients in the right direction. Wider adoption of systems like TLC will enable the health care system to extend higher levels of care to chronic-care patients without driving up costs.

Issues with the current health care approach
Patients experience a huge gap in medical care in the time period between physician office visits. In some cases, patients aren't seen for months at a time, placing a large burden on individuals to comply with and administer their own health care regimen. And unfortunately, in many cases, patients receive little education, training, monitoring or assistance to help them manage their care. For instance, a condition such as hypertension requires regular interaction between patient and physician to prevent relapses and enable the patient to improve.

To illustrate the current physician/patient dynamic, consider the following scenario. A physician meets with a patient and diagnoses the patient's condition. The physician then provides the patient with care instructions and a regimen that usually includes medications and a patient self-care plan. Then, when the patient returns, all too often he/she will not have complied with the care plan and often will not have taken medications as prescribed. Perhaps the patient didn't entirely understand what was being asked, or he/she met a roadblock in self-care that went unaddressed. Or, as a worst case, problems arose, so the patient simply stopped the treatment altogether, never seeking help or assistance to stay on plan. This can cause exacerbations and general worsening of the condition.

But the blame can't lie solely with the patient; there must be some responsibility on the part of the health care provider. In the scenario described above, the system requires the patient or a family member to deliver the care, but the system doesn't promote this in a way for it to be successful. On average, the gap between office visits for patients with chronic disease is over four months. That's much too long of a period for many patients to have no interaction with their physician.

Patients, particularly those who have experienced difficulty with self-care, need a more aggressive, consistent pattern of support and monitoring to manage their chronic health conditions optimally. Health care systems must stop treating chronic health conditions solely through periodic visits and instead adopt an approach of more continuous, consistent care. Doctors need an efficient, cost-effective way to maintain contact with these patients so that they can detect problems early in treatment, determine whether patients are complying with treatment plans and intervene quickly when required.  

With this more proactive approach, physicians will not have to rely as much on the patient and their family to know when intervention is necessary. Patients have not been trained to know when they need physician care, so expecting them to take on the responsibility does not make sense.