Providing high-quality, cost-effective medical care to the L sickest, oldest, and frailest patients remains a formidable challenge. The 18 million people older than 65 years with chronic conditions and limitations in their ability to carry out basic daily activities make up 6% of the nonin-stitutionalized U.S. population but consume 25% of total health care spending (1). The lion's share of these resources go to hospital care: 63% of Medicare patients with 6 or more chronic conditions are hospitalized each year (vs. 13% of those with 2 to 3 chronic conditions) and account for 70% of Medicare 30-day rehospitalizations (2). Although the hospital offers sophisticated and often life-prolonging diagnostic and treatment methods, it can also be a dangerous environment for frail elderly patients. Providing safe and excellent care for this population will probably require developing viable alternatives to hospitalization.
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