The Future Ecology of Care
Authors: Jacob West, Ateev Mehrotra
Journal: Annals of Internal Medicine (2015)

Ideas and Opinions19 April 2016The Future Ecology of CareJacob West, MPP and Ateev Mehrotra, MD, MPHJacob West, MPPFrom Harvard Global Health Institute and Harvard Medical School, Boston, Massachusetts.Search for more papers by this author and Ateev Mehrotra, MD, MPHFrom Harvard Global Health Institute and Harvard Medical School, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1978 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Since its publication more than 50 years ago, “The Ecology of Medical Care” (1) has provided a framework for understanding how persons seek and receive health care. Drawing on diary studies and other data from the United States and the United Kingdom, White and colleagues (1) found that only 2 in 5 persons who are ill consider seeking care and among those, only 2 in 3 eventually receive it. A 2001 follow-up study (2) generated strikingly similar results.But the ecology of medical care may look quite different as the 21st century unfolds, and these prior studies do not capture ...References1. White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med. 1961;265:885-92. [PMID: 14006536] CrossrefMedlineGoogle Scholar2. Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM. The ecology of medical care revisited. N Engl J Med. 2001;344:2021-5. [PMID: 11430334] CrossrefMedlineGoogle Scholar3. Pew Research Center. Health fact sheet. Washington, DC: Pew Research Center; 2015. Accessed at www.pewinternet.org/fact-sheets/health-fact-sheet on 19 November 2015. Google Scholar4. Semigran HL, Linder JA, Gidengil C, Mehrotra A. Evaluation of symptom checkers for self diagnosis and triage: audit study. BMJ. 2015;351:h3480. [PMID: 26157077] doi:10.1136/bmj.h3480 CrossrefMedlineGoogle Scholar5. Fox S; Pew Internet Project; California HealthCare Foundation. Peer-to-peer healthcare. Washington, DC: Pew Research Center; 2011. Accessed at www.pewinternet.org/2011/02/28/peer-to-peer-health-care-2 on 19 November 2015. Google Scholar6. Pearl R. Kaiser Permanente Northern California: current experiences with internet, mobile, and video technologies. Health Aff (Millwood). 2014;33:251-7. [PMID: 24493768] doi:10.1377/hlthaff.2013.1005 CrossrefMedlineGoogle Scholar7. Leff B, Burton L, Mader SL, Naughton B, Burl J, Inouye SK, et al. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143:798-808. [PMID: 16330791] LinkGoogle Scholar8. Yamamoto DH. Assessment of the feasibility and cost of replacing in-person care with acute care telehealth services. Barrington, IL: Red Quill Consulting; 2014. Accessed at www.connectwithcare.org/wp-content/uploads/2014/12/Medicare-Acute-Care-Telehealth-Feasibility.pdf on 19 November 2015. Google Scholar9. Brooks R. Mayo Clinic offers a real-time medical concierge for anyone anywhere [video]. New York: PSFK; 2014. Accessed at www.psfk.com/2014/04/mayo-clinic-electronic-diagnosis.html on 19 November 2015. Google Scholar10. Along with hot controversies, some hot medical discoveries. Life. 7 July 1961:34-5. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard Global Health Institute and Harvard Medical School, Boston, Massachusetts.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1978.Corresponding Author: Ateev Mehrotra, MD, MPH, Harvard Medical School, 180A Longwood Avenue, Boston, MA 02466; e-mail, [email protected]med.harvard.edu.Current Author Addresses: Mr. West: Harvard Global Health Institute, 42 Church Street, Cambridge, MA 02138.Dr. Mehrotra: Harvard Medical School, 180A Longwood Avenue, Boston, MA 02466.Author Contributions: Conception and design: J. West, A. Mehrotra.Analysis and interpretation of the data: J. West.Drafting of the article: J. West.Critical revision of the article for important intellectual content: J. West, A. Mehrotra.Final approval of the article: J. West, A. Mehrotra.Administrative, technical, or logistic support: A. Mehrotra.Collection and assembly of data: J. West.This article was published at www.annals.org on 26 January 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByBackslide or forward progress? Virtual care at U.S. healthcare systems beyond the COVID-19 pandemicThe theory of change of the evaluation support program: Enhancing the role of community organizations in providing an ecology of care for neurological disordersDeclining Use of Primary Care Among Commercially Insured Adults in the United States, 2008–2016Ishani Ganguli, MD, MPH, Zhuo Shi, BA, E. John Orav, PhD, Aarti Rao, BA, Kristin N. Ray, MD, MS, and Ateev Mehrotra, MD, MPHTelemedicine and TelehealthCoordination Across Ambulatory CareTelemedicine and Telehealth 19 April 2016Volume 164, Issue 8Page: 560-561KeywordsComputer applicationsEcologyForecastingHealth careHealth care providersMedical dialysisPatientsPopulation statisticsPsychiatry and mental health ePublished: 26 January 2015 Issue Published: 19 April 2016 CopyrightCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...