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(Chest. 2004;125:695-703.)
© 2004 American College of Chest Physicians

Integrated Health System for Chronic Disease Management*

Lessons Learned From France

Mary Stuart, ScD and Michael Weinrich, MD

* From the Department of Sociology and Anthropology (Dr. Stuart), Director, Health Administration and Policy Program, University of Maryland Baltimore County; and the National Center for Medical Rehabilitation Research (Dr. Weinrich), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

Correspondence to: Mary Stuart, Department of Sociology and Anthropology, UMBC 1000 Hilltop Circle, Baltimore, MD 21250; e-mail: stuart{at}umbc.edu

Rated number one in overall health system performance by the World Health Organization, the French spend less than half the amount on annual health care per capita that the United States spends. One contributing factor may be the attention given to chronic care. Since the mid-1900s, the French have developed regional community-based specialty systems for patients with chronic respiratory insufficiency or failure. COPD is the major cause of respiratory failure, the fourth leading cause of death in the United States, and its prevalence is increasing. Despite the clinical success of home mechanical ventilation and the potential for cost savings, providing such services in the United States remains a challenge. Lessons from France can inform the development of cost-effective chronic care models in the United States In this article, we review the French experience in the context of the United States Supreme Court’s Olmstead decision, mandating that people in "more restrictive settings" such as nursing homes be offered community-based supports. We suggest that regional demonstration projects for patients with chronic respiratory failure or insufficiency can provide an important step in the development of effective chronic care systems in the United States

Key Words: chronic care model • home ventilation • Olmstead decision • respiratory insufficiency or failure




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