Rebuilding Chronic Care

Published: November 30, 2006

Providence St. Peter Clinic

Improving Chronic Illness Care

More than 130 million Americans—almost half of us—suffer from diabetes, depression or some other chronic conditions. Often, the multiple health care providers tending to these patients do not coordinate their care. Frequently, they fail to follow recommended standards of treatment. Patients themselves could take more responsibility for their own care if they knew what to do. Too many times, no one shows them how.

Improving Chronic Illness Care (ICIC), a national program of the Robert Wood Johnson Foundation, is dedicated to improving chronic conditions health care. ICIC has demonstrated that care for chronically ill patients can be improved with redesigned medical offices, new roles for patients and caregivers, and enhanced clinical information systems. What's more, this new approach can reduce overall health care costs while improving outcomes.

One example: the Providence St. Peter Family Clinic in Olympia, Wash. After implementing the Chronic Care Model, with its emphasis on patient self-management and innovations in care delivery, the clinic has seen significant improvements in patient health and staff morale.

The Chronic Care Model has dramatically improved health care delivery and staff morale at the clinic, and results have been similarly positive at other Improving Chronic Illness Care (ICIC) sites around the country. ICIC reflects the commitment of the Robert Wood Johnson Foundation to ensuring that all Americans, especially those with chronic conditions, receive high-quality care, particularly in outpatient settings.

The Chronic Care Model identifies the essential elements of a health care system that encourage high-quality chronic disease care: the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. The model can be applied to a variety of chronic illnesses, health care settings and target populations. The bottom line is healthier patients, more satisfied providers, and cost savings.


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Listed below are 2 of the grants that supported this project, totaling $1,620,598.

Grant Awarded to Amount
Developing and testing nondirection support approaches for diabetes self-management Providence St. Peter Hospital (Olympia, WA)
ID#: 050608
Actual award: $440,000
May 2004 to February 2007
This grant has ended.
Technical assistance and direction for RWJF's Improving Chronic Illness Care program Group Health Cooperative (Seattle, WA)
ID#: 048769

http://www.ghc.org
Approved award: $1,197,956
Actual award: $1,180,598
April 2005 to December 2006
This grant has ended.

RWJF may have supported this project with other grants that are not listed.

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An Evaluation of Collaborative Interventions to Improve Chronic Illness Care

By:
Cretin S, Shortell SM and Keeler EB

Publication date:
February 2004

Summary:
The Chronic Care Model (CCM) was designed to foster improvements in care of patients with chronic illnesses. This research describes a program designed to use quality improvement collaboration to induce providers, organizations and patients to make changes...

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Evidence on the Chronic Care Model in the New Millennium

By:
Coleman K, Austin BT, Brach C and Wagner EH

Publication date:
January/February 2009

Summary:
This paper reviews evidence published since 2000 about practices' ability to redesign care in accord with the Chronic Care Model (CCM) and the impacts of such redesign on clinical care and health outcomes. Implications for practice and research are discussed.

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Early Experiences With Consumer Engagement Initiatives To Improve Chronic Care

By:
Hurley RE, Keenan PS, Martsolf GR, Maeng DD and Scanlon DP

Publication date:
January/February 2009

Summary:
This paper investigates the early experiences of the 14 regional multistakeholder quality improvement alliances funded by the Robert Wood Johnson Foundation in 2006 to design and implement communitywide consumer engagement strategies.

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Rethinking Prevention in Primary Care

By:
Hung DY, Rundall TG, Tallia AF, Cohen DJ, Halpin HA and Crabtree BF

Publication date:
January 2007

Summary:
This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such as tobacco use, risky drinking, unhealthy dietary patterns and physical inactivity. Data were obtained from primary care practices participating in a national...

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Coaching Academic Medical Centers in the Chronic Care Model

Publication date:
August 22, 2008

Summary:
From 2005 to 2007, project staff at the Association of American Medical Colleges provided education and coaching to teams at 22 academic health centers that were implementing the Chronic Care Model - a system to improve the care of chronically ill patients.

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Health Insurance Reform Project Identifies New Ideas to Improve Federal Health Policy - Voluntary Chronic Care Improvement Programs and Tax Credits

Publication date:
October 03, 2005

Summary:
The Health Insurance Reform Project worked to develop and advance new ideas to improve federal health policy, focusing primarily on improving quality in Medicare and expanding health insurance coverage nationally.

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Chronic Care in America

Publication date:
Aug 31, 1996

Summary:
This report provides an overview of a growing issue facing the nation: how to provide appropriate health care and related social services to people living with chronic health conditions.

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Waste, Inefficiencies and Inequalities in Chronic Care Management

Publication date:
December 29, 2006

Summary:
An examination of chronic care management among the elderly uncovers waste, inequality and inefficiencies and highlights areas for improvement

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