title: Practical aspects of integrating allergy and pulmonology management into a rhinology practice:  the Vanderbilt ASAP experience.
abstract: OBJECTIVE
  In the aftermath of reforms in healthcare laws, there is a focused conversation concerning healthcare delivery with an increasing emphasis on quality, cost containment, improved outcomes and access. Concurrently, providers are experiencing pressure as patient volume escalates yet while funding levels fail to keep pace. Addressing these issues is imperative to the medical practices. In this review, the integration of an allergy and rhinology practice into a center focused on managing chronic airway disease is detailed in the examination of an existing practice.
  
  
  RESULTS
  In 2010, healthcare spending in the Unites States was nearly US$ 2.6 trillion, 17.9% of the nation's gross domestic product and 10 times 1980 levels. Insurance premiums have increased 113% since 2001 and continue to outpace income gains. Seventy-five percent of spending is attributed to chronic diseases such as stroke, cancer, heart disease, diabetes, Parkinson's disease and Alzheimer's. Airway disease (rhinitis, sinusitis, asthma, chronic obstructive pulmonary disease) is one of the largest chronic disease states. In fact, more patients suffer from airway disease than the aforementioned diseases in total. Any effort to affect costs must include a chronic disease strategy. This review will focus on the nature of the integrated program and its relation to the nature of airway diseases; a detailed description of how it works and why it is different from traditional models.
  
  
  CONCLUSIONS
  This integrated model of healthcare will improve the quality of care provided to airway disease patients as well as help contain overall healthcare cost.
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: James
authors.initials: J
authors.lastname: Duncavage
authors.forename: David D
authors.initials: DD
authors.lastname: Hagaman
mesh_terms: D000486:Allergy and Immunology / Q000639:trends*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019468:Disease Management; D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006801:Humans; D010036:Otolaryngology / Q000639:trends*; D010348:Patient Care Team / Q000639:trends; D015272:Pulmonary Medicine / Q000639:trends*; D011787:Quality of Health Care; D013714:Tennessee; D014481:United States