As good as it gets? Chronic care management in nine leading US physician organisations

doi:10.1136/bmj.325.7370.958

BMJ 2002;325:958-961 ( 26 October )

Education and debate

As good as it gets? Chronic care management in nine leading US physician organisations

Thomas G Rundall, professor ^a, Stephen M Shortell, professor ^a, Margaret C Wang, research assistant ^a, Lawrence Casalino, assistant professor ^b, Thomas Bodenheimer, clinical professor of family and community medicine ^c, Robin R Gillies, research director ^a, Julie A Schmittdiel, research assistant ^a, Nancy Oswald, president ^d, James C Robinson, professor ^a.

^a University of California at Berkeley, School of Public Health, Division of Health Policy and Management, 140 Warren Hall, Berkeley, California, USA 94720-7360, ^b The University of Chicago, Department of Health Studies, 5841 South Maryland Avenue, MC 2007, Chicago, Illinois, USA 60637, ^c University of California at San Francisco, Building 80-83, San Francisco General Hospital, 101 Potrero Avenue, San Francisco, California, USA 94110, ^d Healthcare Consulting, 61 Rock Lane, Berkeley, California, USA 94708

Correspondence to: T G Rundall trundall@uclink.berkeley.edu

The first 150 words of the full text of this article appear below.

Innovations in care management processes have improved the care of patients with chronic illnesses, but many patients stilldo not receive these benefits. The authors have studied the barriersand facilitators to implementing these improvements in leadingUS physician practices

About 125 million of the 276 million people living in the United States have some type of chronic illness (table 1).¹Four chronic conditions affect nearly half of Americans with achronic disease: asthma, depression, and diabetes each affectabout 15 million,^2-4 while five million have congestive heartfailure.⁵ In 1999 these four chronic diseases were directlyresponsible for 140 000 deaths in the United States⁶ and generatedat least $173bn (£108bn, 170bn) in medical and other costs. ⁵ ^7-9

Over the past decade the effectiveness of care for patients with these and other major chronic illnesses has been improvedby innovations in care management processes such as the use ofguidelines, disease management techniques, case . . . [Full text of this article]

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