Feature Story

January 6, 2009

Chronic Care Model helps improve people's health and care

From EurekAlert! - Breaking News:

Over 1,500 US and international medical practices --"more than we ever dreamed," says Dr. Ed Wagner -- have adopted the Chronic Care Model. With Robert Wood Johnson Foundation support, he and Group Health colleagues developed this framework to redesign daily medical practice. The Chronic Care Model spurred the Medical Home to renew primary care. Now the largest roundup of evidence on the Model confirms that it really works, helping people stay healthier and get better care.

This review is in the January/February 2009 issue of Health Affairs, focused on a key part of reforming health care: caring for chronic diseases in a "fragmented" health care system. health care is set up for quick fixes to acute problems," said lead author Katie Coleman, MSPH, a research associate at Group Health Center for Health Studies.

"Redesigning medical practices according to the Model generally improved health care and helped patients control a broad range of chronic diseases," Coleman said. He directs the MacColl Institute for Healthcare Innovation at Group Health Center for Health Studies. Not only helping people care for their own diseases, Model-based interventions also help medical practices make clinical changes to redesign how they deliver health care.

The Chronic Care Model comprises six interrelated system changes: effective team care; planned interactions; self-management support; community resources; integrated decision support; and patient registries and other supportive information technology (IT). Registries track patients with specific chronic diseases, helping medical teams to make the most of each office visit and follow evidence-based care guidelines. One promising option, with growing "buzz," is a reinvention of general or primary care that Group Health has piloted and is adopting at all its 26 medical centers: the Patient-Centered Medical Home.

Founded in 1947, Group Health Cooperative is a Seattle-based, consumer-governed, nonprofit health care system that coordinates care and coverage. For 25 years, Group Health Center for Health Studies has conducted research on preventing, diagnosing, and treating major health problems.

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