Abstract
Medical care in the USA is plagued by high costs, poor quality and fragmented care delivery. In response, new methods of integrated healthcare delivery are needed, including the patient-centered medical home. At the same time, we need to revitalize our approach to the practice of medicine, moving to a personalized approach, even as we increasingly focus on population management. Some aspects of personalized healthcare have the potential to add significant cost to the system, while others can improve value. This article aims to provide an overview of the current healthcare climate, discuss evolving models of care in the era of healthcare reform and describe the increasingly important role of personalized healthcare in this process.
Papers of special note have been highlighted as: ▪ of interest
References
- 1 Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Aff. (Millwood) W4–184–197 (2004).Google Scholar
- 2 Goodman DC, Esty AR, Fisher ES, Chang C. Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness. The Dartmouth Institute for Health Policy and Clinical Practice, NH, USA (2011).Google Scholar
- 3 Patient Protection and Affordable Care Act of 2010. Pub. L. No. 111–148, 3022 124 (2010).Google Scholar
- 4 Porter ME, Teisberg EO. Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business School Publishing, MA, USA (2006).▪ Provides an overview and important viewpoint surrounding the issues facing the US healthcare delivery system.Google Scholar
- 5 Peikes D, Zutshi A, Genevro J, Smith K, Parchman M, Meyers D. Early evidence on the patient-centered medical home. Final Report (prepared by Mathematica Policy Research, under contract oos. HHSA290200900019I/HHSA29032002T and HHSA290200900019I/HHSA29032005T). AHRQ Publication Number 12-0020-EF (February 2012).Google Scholar
- 6 Bojadzievski T, Gabbay RA. Patient-centered medical home and diabetes. Diabetes Care34(4),1047–1053 (2011).Crossref, Medline, Google Scholar
- 7 McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health Aff. (Millwood)29(5),982–990 (2010).Crossref, Medline, Google Scholar
- 8 Berwick DM. Launching accountable care organizations – the proposed rule for the Medicare Shared Savings Program. N. Engl. J. Med.364(16),e32 (2011).Crossref, Medline, Google Scholar
- 9 Hampel H, Frankel WL, Martin E et al. Feasibility of screening for Lynch syndrome among patients with colorectal cancer. J. Clin. Oncol.26(35),5783–5788 (2008).Crossref, Medline, Google Scholar
- 10 Jarvinen HJ, Aarnio M, Mustonen H et al. Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer. Gastroenterology118(5),829–834 (2000).Crossref, Medline, CAS, Google Scholar
- 11 Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP working group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from lynch syndrome in relatives. Genet. Med.11(1),35–41 (2009).▪ Provides recommendations from an authority working group with regard to genetic testing strategies for patients who are newly diagnosed with colorectal cancer. This paper is useful for guiding decision support for readers with regard to reducing morbidity and mortality from Lynch syndrome.Crossref, Medline, Google Scholar
- 12 Ladabaum U, Wang G, Terdiman J et al. Strategies to identify the lynch syndrome among patients with colorectal cancer: a cost–effectiveness analysis. Ann. Intern. Med.155(2),69–79 (2001).Crossref, Google Scholar
- 13 Edwards QT, Maradiegue A, Seibert D, Jasperson K. Pre- and postassessment of nurse practitioners’ knowledge of hereditary colorectal cancer. J. Am. Acad. Nurse Pract.23(7),361–369 (2011).Crossref, Medline, Google Scholar
- 14 Burt RW. Who should have genetic testing for the Lynch syndrome? Ann. Intern. Med.155(2),127–128 (2011).Crossref, Medline, Google Scholar
- 15 Ishii N, Arai M, Koyama Y et al. Factors affecting encouragement of relatives among families with Lynch syndrome to seek medical assessment. Fam. Cancer10(4),649–654 (2011).Crossref, Medline, Google Scholar
- 16 Yamamoto H, Adachi Y, Taniguchi H et al. Interrelationship between microsatellite instability and microRNA in gastrointestinal cancer. World J. Gastroenterol.18(22),2745–2755 (2012).Crossref, Medline, CAS, Google Scholar
- 17 Bonnet D, Selves J, Toulas C et al. Simplified identification of Lynch syndrome: a prospective, multicenter study. Dig. Liver Dis.44(6),515–522 (2012).Crossref, Medline, Google Scholar
- 18 Pinol V, Castells A, Andreu M et al. Accuracy of revised Bethesda guidelines, microsatellite instability, and immunohistochemistry for the identification of patients with hereditary nonpolyposis colorectal cancer. JAMA293(16),1986–1994 (2005).Crossref, Medline, CAS, Google Scholar
- 19 Martin MA, Klein TE, Dong BJ et al. Clinical pharmacogenetics implementation consortium guidelines for HLA-B genotype and abacavir dosing. Clin. Pharmacol. Ther.91(4),734–738 (2012).Crossref, Medline, CAS, Google Scholar
- 20 Mallal S, Phillips E, Carosi G et al.HLA-B*5701 screening for hypersensitivity to abacavir. N. Engl. J. Med.358(6),568–579 (2008).Crossref, Medline, Google Scholar
- 21 Epstein R, Teagarden JR. Comparative effectiveness and personalized medicine: evolving together or apart? Health Aff. (Millwood)29(10),1783–1787 (2010).Crossref, Medline, Google Scholar
- 22 Armstrong K. Can genomics bend the cost curve? JAMA307(10),1031–1032 (2012).Crossref, Medline, CAS, Google Scholar
- 23 Lo SS, Mumby PB, Norton J et al. Prospective multicenter study of the impact of the 21-gene recurrence score assay on medical oncologist and patient adjuvant breast cancer treatment selection. J. Clin. Oncol.28(10),1671–1676 (2010).Crossref, Medline, Google Scholar
- 24 Lyman GH, Cosler LE, Kuderer NM, Hornberger J. Impact of a 21-gene RT-PCR assay on treatment decisions in early-stage breast cancer: an economic analysis based on prognostic and predictive validation studies. Cancer109(6),1011–1018 (2007).Crossref, Medline, Google Scholar
- 25 Hillner BE, Smith TJ. Do the large benefits justify the large costs of adjuvant breast cancer trastuzumab? J. Clin. Oncol.25(6),611–613 (2007).Crossref, Medline, Google Scholar
- 26 Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African–Americans toward participation in medical research. J. Gen. Intern. Med.14(9),537–546 (1999).Crossref, Medline, CAS, Google Scholar
- 27 Scharff DP, Mathews KJ, Jackson P, Hoffsuemmer J, Martin E, Edwards D. More than Tuskegee: understanding mistrust about research participation. J. Health Care Poor Underserved21(3),879–897 (2010).Crossref, Medline, Google Scholar
- 28 Epstein AM, Ayanian JZ. Racial disparities in medical care. N. Engl. J. Med.344(19),1471–1473 (2001).Crossref, Medline, CAS, Google Scholar
- 29 Pearson TA. Capacity for research in minority health: the need for infrastructure plus will. Am. J. Med. Sci.322(5),243–247 (2001).Crossref, Google Scholar
- 30 Alexander M, Grumbach K, Remy L, Rowell R, Massie BM. Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity. Am. Heart J.137(5),919–927 (1999).Crossref, Medline, CAS, Google Scholar
- 31 Yancy CW, Fowler MB, Colucci WS et al. Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. N. Engl. J. Med.344(18),1358–1365 (2001).Crossref, Medline, CAS, Google Scholar
- 32 Hassaballa H, Gorlick PB, West CP, Hansen MD, Adams HP. Ischemic stroke outcomes: racial differences in the trial of danaparoid in acute stroke (TOAST). Neurology57(4),691–697 (2001).Crossref, Medline, CAS, Google Scholar
- 33 Wood AJ. Racial differences in the response to drugs – pointers to genetic differences. N. Engl. J. Med.344(18),1394–1396 (2001).▪ One of the first suggestions that there may be differences in genetic determinants that impact how different racial groups respond to medications.Crossref, Medline, CAS, Google Scholar
- 34 Yancy CW. Heart failure in blacks: etiologic and epidemiologic differences. Curr. Cardiol. Rep.3(3),191–197 (2001).Crossref, Medline, CAS, Google Scholar
- 35 Exner DV, Dries DL, Domanski MJ, Cohn JN. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N. Engl. J. Med.344(18),1351–1357 (2001).Crossref, Medline, CAS, Google Scholar
- 36 McNamara DM, Tam SW, Sabolinski ML et al. Endothelial nitric oxide synthase (NOS3) polymorphisms in African Americans with heart failure: results from the A-HeFT trial. J. Card. Fail.15(3),191–198 (2009).Crossref, Medline, CAS, Google Scholar
- 101 Centers for Medicare & Medicaid Services. National health expenditures aggregate, per capita amounts, percent distribution, and average annual percent change: selected calendar years 1960–2010 (table 1). www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/tables.pdfGoogle Scholar
- 102 Centers for Medicare & Medicaid Services. National health expenditures aggregate, per capita amounts, percent distribution, and average annual percent change: selected calendar years 2006–2021 (table 2). www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdfGoogle Scholar
- 103 The Commonwealth Fund. U.S. ranks last among seven countries on health system performance based on measures of quality, efficiency, access, equity, and healthy lives (2010). www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdfGoogle Scholar
- 104 Patient-Centered Primary Care Collaborative. Joint principles of the patient-centered medical home (2007). www.pcpcc.net/content/joint-principles-patient-centered-medical-home▪ Important for those interested in gaining a deeper understanding of the components of a patient-centered medical home.Google Scholar
- 105 National Committee for Quality Assurance. Patient-centered medical home (2011). www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspxGoogle Scholar
- 106 Grumbach K, Grundy P. Outcomes of implementing patient centered medical home interventions: a review of the evidence from prospective evaluation studies in the United States.Patient-Centered Primary Care Collaborative (2010). www.pcpcc.net/document/evidence-quality▪ Presents a review of patient-centered medical home pilots and their outcomes, and is useful evidence for organizations interested in investing in this model of healthcare delivery.Google Scholar
- 107 Centers for Medicare and Medicaid Services. Medicare Accountable Care Organizations Shared Savings Program. www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogramGoogle Scholar
- 108 Department of Health and Human Services. Federal Register. Vol. 76, No. 67 (2011). http://edocket.access.gpo.gov/2011/pdf/2011–7880.pdfGoogle Scholar
- 109 Department of Health and Human Services. Federal Register. Vol. 76, No. 212 (2011). www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdfGoogle Scholar
- 110 Department of Health and Human Services. Personalized health care: pioneers, partnerships, progress (2008). www.hhs.gov/myhealthcare/news/presonalized-healthcare-2008.htmlGoogle Scholar
- 111 FRAX®. WHO fracture risk assessment tool. www.shef.ac.uk/FRAX/?lang=enGoogle Scholar
- 112 National Cancer Institute Breast Cancer Risk Assessment Tool. www.cancer.gov/bcrisktoolGoogle Scholar
- 113 US FDA. Table of pharmacogenomic biomarkers in drug labels (2013). www.fda.gov/drugs/scienceresearch/researchareas/pharmacogenetics/ucm083378.htmGoogle Scholar

