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Director's Letter

The complexity of health care delivery has increased substantially during the past two decades, the result of better understanding of disease pathophysiology, the dramatic growth in diagnostic evaluations and treatments, increased prevalence of chronic disease co-morbidity, lengthening lifespan, and the transformation of health care delivery from inpatient to outpatient environments. Complexity of health care delivery has increased further because of the unrelenting growth in health care costs and the subsequent need for greater efficiency of care (e.g., evaluate more patients in a given time). Reduced patient-provider communication is an unfortunate by-product of medical progress.

Computerization provides one hopeful approach to increasing the amount of time available for communication. Computerization facilitates the aggregation of clinically meaningful data, the transformation of data into information, and the effective presentation of information to providers at the point-of-care. To date, only a barely measurable fraction of the computer's potential impact on health care and time availability has been realized. The hospital and clinic patient centered medical home, in which a multidisciplinary team coordinates care to support the patient, promises not only to improve quality and efficiency of care, but also facilitate communication. Nevertheless, meaningful communication will inevitably continue to be squeezed by the limits of time.

Because emotional issues are so prominent among Veteran and civilian populations, and their impact on physical health and quality of life so high, developing improved approaches to effective communication are more essential then ever. Developing simple methods to measure communication, developing and testing models of communication, developing new approaches to educating providers in the art of communication, identifying changeable factors that have a high impact on communication and approaches to implementing positive change, and understanding the impact of more effective communication on patient outcomes are all imperative research issues.