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• W2024002373 abstract "M edical practice is undergoing perhaps its most dramatic change of this century. A revolution in the prevailing medical paradigm driven largely by payors and large insurers is resulting in an aggressive challenge to the value of complex, high-technology medical care and the specialists who use such care.l At the same time, government and industry investment in biotechnology is fueling an explosion in the development of complex new therapies with expanded possibilities of patient benefit.2 As the health care system struggles to adapt to the constraints of capitated payments and managed care, it will be oriented toward vertical integration with a focus on primary care.3 In this environment we believe that the preservation of high-quality care for patients with complex diseases will be critically dependent on having access to information that defines the value of medical technology and identifies areas in which generalists or specialists should provide ongoing care. This era has arrived more than 20 years after it was initially predicted by the founders of our group.4 Because of its prominence in terms of quantifiable outcomes and cost, cardiovascular medicine is at the forefront of this revolution. Whereas medicine has recently experienced a quantum leap in access to information technologies, the medical profession continues to lag far behind the business community in the collection and use of information. Over 20 years ago, the stated goal of the Duke Databank for Cardiovascular Disease was to create a resource to support daily clinical practice so that “no clinical decisions will be made on the care of any patient with coronary artery disease, myocardial infarction, or heart block until the data bank has been searched and outcomes of patients with the same descriptors as the new patient have been given to the physician. When Duke Medical Center can immediately bring to bear all its experience on each cardiovascular patient entering its doors, it will have a clear lead over all other physicians.“4 Our tenet is that unless cardiology can achieve the goal delineated above, in an era in which the domain of the cardiovascular specialist (and other specialists) will be increasingly circumscribed by default, patients will be deprived of significant opportunities for improved outcomes because a rational basis will not be available for determining when and how specialty care can produce benefit." @default.
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• W2024002373 date "1995-12-01" @default.
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• W2024002373 title "The way of the future redux" @default.
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• W2024002373 doi "https://doi.org/10.1016/s0002-9149(99)80331-2" @default.
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