Systems Approaches to Improve Quality, Performance, and Efficiency in the Care of Older Adults

Systems Approaches to Improve Quality, Performance, and Efficiency in the Care of Older Adults

By David B Reuben, MD

Spring 2007 - Volume 11 Number 2


In the early years of the 21st century, the US health care system is in a state of both feast and famine. New scientific breakthroughs and advances in technology have cured diseases and extended lives beyond what was imaginable even a decade ago. Yet despite these riches, the health care system is fundamentally broken. It fails on three measures of care, especially in the treatment of older persons.

The first measure is cost. In 2004, the cost of health care in the United States grew at a rate of 7.7%, compared to the overall consumer price index of 4.4%.1 In fact, many US economists have accepted--but do not like--that health care spending will rise at a rate of 2% to 3% higher than the general economy.

etoc emailClick here to join the eTOC list or text TPJ to 22828. You will receive an Email notice with the Table of Contents of each issue.

The Permanente Journal advances knowledge in scientific research, clinical medicine and innovative health care delivery. It is a peer-reviewed journal of medical science, social science in medicine, and medical humanities.

The Permanente Press

The Permanente Press publishes The Permanente Journal and books related to health care. For information about subscriptions, missing issues, billing, subscription renewal, and back issues, Email:


27,000 print readers per quarter, 15,350 eTOC readers, and in 2018, 2 million page views of TPJ articles in PubMed from a broad international readership.


The Kaiser Permanente National CME Program designates this journal-based CME activity for 4 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ISSN 1552-5767 Copyright © 2019

All Rights Reserved.