Circadian rhythms are endogenous 24-hour oscillations in biologic processes that drive nearly all physiologic and behavioral functions. Disruption in circadian rhythms can adversely impact short- and long-term health outcomes. Routine hospital care often causes significant disruption in sleep-wake patterns that is further compounded by loss of personal control of health information and health decisions. We wished to evaluate measures directed at improving circadian rhythm and access to daily health information on hospital outcomes.

Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record.

A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change.

Hypertension (HTN) is the most common chronic disease in the U.S., and the standard model
of office-based care delivery has yielded suboptimal outcomes, with approximately 50% of
affected patients not achieving blood pressure (BP) control. Poor population-level BP control
has been primarily attributed to therapeutic inertia and lowpatient engagement. New models
of care delivery utilizing patient-generated health data, comprehensive assessment of social
health determinants, computerized algorithms generating tailored interventions, frequent
communication and reporting, and non-physician providers organized as an integrated
practice unit, have the potential to transform population-based HTN control.

Chronic disease represents the epidemic of our time, present in half the adult population and responsible for 86% of United States (US) healthcare costs and 70% of deaths. The major chronic diseases are primarily due to health risk behaviors that are widely communicable across populations. Now new opportunities exist as a result of recent advances in home-based wireless devices, apps and wearables, enabling health delivery systems to monitor disease metrics in near real time. These technologies provide a framework for patient engagement and a new model of care delivery utilizing integrated practice units, both of which are needed to navigate the healthcare needs of the 21st century.

Chronic disease is responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. Modifying our delivery model to include team-based care working in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic.