From 1994 to 1997, staff at the Group Health Cooperative of Puget Sound developed and evaluated a new approach to providing managed primary care to patients with chronic conditions within specialized chronic care clinics that facilitate collaboration among patients, families and clinicians.
Based in Seattle, Group Health Cooperative of Puget Sound is a consumer-governed, nonprofit health care system that coordinates care and coverage.
The project was part of the Robert Wood Johnson Foundation (RWJF) Chronic Care Initiatives in HMOs national program.
Project staff found barriers to implementation:
- Difficulty shifting from a reactive care culture to a proactive one.
- Lack of a geriatric focus and expertise.
- Limited incentives and processes for changing the chronic care clinic.
- Downsizing and instability of these clinics.
Despite the barriers, physicians supported the clinic approach; nurses felt it was appropriate and satisfying work; and newly sensitized leadership was encouraged by the clinics' progress.