Submaximal Decision Theory and Health Resource Conservation

The challenge of eliminating disparities in chronic illness in the United States is hampered by the diversity of the epidemiology of the chronic conditions themselves, and by the individuality of the communities and patients affected by them. This article outlines some of the ways in which the complexity of chronic illness in underserved communities in the United States limits the data and the strategies available to clinicians and patients. We then present the example of chronic heart failure (CHF) to illustrate a possible solution that we are developing for supporting underserved patients’ selfmanagement of chronic illness: individualized health care (through “personal normals” derived from the patient’s own clinical history combined with population-based data), and distributed health care (point of care through wireless biosensors and community health workers). We present some of the possible barriers to the implementation of the model. Conclusion: we believe that this approach is a pathway to empowering CHF patients in underserved communities. Further research is necessary to test the clinical viability of the model and the acceptability of the model for patients, physicians, and families.