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To the Editor: Dr Bodenheimer and colleagues¹ described a "collaborative care program for chronic disease management." The authors proposed increased "self-management education" as a central feature of their program. Unfortunately, this intervention is limited in scope and ignored a comprehensive systems-approach that has proven to be innovative and effective. For instance, the Diabetes Control and Complications Trial succeeded in decreasing and sustaining a significantly lowered hemoglobin A_1c level during the 10-year duration of the trial.²

My colleagues and I have described a similar comprehensive systems-approach for enhancing long-term care.^3-4 We have described several interdependent components that must implemented for the successful management of chronic diseases and health maintenance. Modern communications technologies are generally lacking in the infrastructure of the existing health care system. These must be developed to serve as the glue that bonds the components together. Such a system, however, requires recognition by patients, physicians, payers, and the public . . . [Full Text of this Article]

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