"This article describes the dysfunctional delivery of existing conservative care practices in the treatment of osteoarthritis (OA) within the context of a dynamic environment of health reform. It is written from the patient perspective of one of the authors who is afflicted with OA and with the added clinical view of a rheumatologist. The authors envision benefits of more cost-effective care, a decrease in the impact of chronic illness on the financial viability of the United States, and an improvement in the quality of care provided to patients. These benefits can be achieved with tested innovations organized within the integrated delivery system described in this article."
The United States health system is now facing serious pressure to become more cost-effective, to show value for health expenditure, and to decrease discontinuity from volume-based medical conditions in the life cycle of an illness. Drs. Gruber and Hunter in their 2010 Clinics in Geriatric Medicine article refer to this as the "illness severity continuum value chain/total life cycle."
Physicians now provide care with major gaps in their knowledge of the "whole" patient. There are multiple specialists and other health professionals but there is little integration of care and little follow-on care after a treatment or monitoring of outcomes in the patient illness life cycle. Figure 3, below, represents the pain life cycle in the current healthcare delivery model of osteoarthritis.
Figure 3. Gruber-Hunter Osteoarthritis Severity Continuum Value Chain/Total Life Cycle 
Gruber-Hunter “Transforming Osteoarthritis Care in an Era of Health Care Reform” Clinics in Geriatric Medicine, 2010
For the full article visit the Clinics in Geriatrics website

© 2019 William H. Gruber