Program Model Identifies Ways of Improving Chronic Illness Care

Planning for programs of chronic disease management in organized health systems

These grants from the Robert Wood Johnson Foundation (RWJF) supported the planning of its national program to improve the quality of care received by patients with chronic conditions, Improving Chronic Illness Care.

Earlier grants to the Group Health Cooperative of Puget Sound (see the Program Results Reports on ID#s 024739 and 028681 under the Chronic Care Initiatives in HMOs program) had produced a model for effective collaborative management of chronic disease in managed health care.

Key Results

  • Under these two planning grants, the project team refined that model, conducted a literature review, published a database of interventions in chronic illness, and surveyed 72 innovative chronic disease management programs by phone and/or through site visits.

    Dissemination activities under these planning grants included one book, more than a dozen articles published in journals, and 15 presentations.

Key Findings

  • The team found three common deficiencies limiting program effectiveness:

    • Lack of a population-based perspective for service delivery.
    • Weak support for self-management of illness.
    • Incomplete implementation, mainly because of physician resistance or inertia.

Afterward: Based on this information, RWJF staff proposed Improving Chronic Illness Care, a national program, which its Board of Trustees approved in April 1998. The program has three components:

  • A clinical improvement and evaluation component to implement the model.
  • Targeted research grants.
  • A dissemination and technical assistance component.

The national program office is housed at the Group Health Cooperative of Puget Sound, with Edward H. Wagner, MD, MPH, as national program director.