The health care system in the United States delivers much good high-quality care but also causes unnecessary harm. This harm has many guises—some visible, such as hospital-acquired infections, and others more subtle, such as failure to prescribe indicated treatment or communicate effectively.1,2 Individuals with chronic conditions may be particularly vulnerable to the shortcomings of the delivery system. The care of these individuals crosses organizational boundaries—primary care and subspecialty, hospital and community. Although defects certainly occur within systems, the likelihood and severity of errors increase substantially at the crevasses between systems.
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