Intended for healthcare professionals


Advances in managing chronic disease

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:525

Research, performance measurement, and quality improvement are key

  1. Ronald M Davis, North American editor (,
  2. Edward G Wagner, director,
  3. Trish Groves, primary care editor
  1. BMJ
  2. Sandy MacColl Institute for Healthcare Innovation, Group Health Cooperative of Puget Sound, Seattle, WA 98191, USA
  3. BMJ

    Chronic diseases have been around as long as humans. But now, in most industrialised nations and in many developing countries, they predominate among the leading causes of death.1 For many years public health practitioners have recognised the increasing burden of chronic illness.2

    Just as chronic disease control has developed into a distinct discipline in public health, so chronic disease management is beginning to develop its own identity as an important component of health care. No longer is each chronic illness—asthma, diabetes, arthritis, etc—being considered in isolation. Awareness is increasing that similar strategies can be equally effective in treating many different conditions. In recognition of the maturing field, this issue of the BMJ—and the February issue of its sister journal, the Western Journal of Medicine—is devoted to chronic disease management.

    Three essential ingredients are required for continued progress in chronic disease management: research, performance measurement, and quality improvement. Research on innovative methods to treat people with chronic illness should be high on the agenda of organisations that fund health research. The Robert Wood Johnson Foundation, a leading American philanthropic institution, has already designated chronic disease care as one of its major priorities (, and its programme emphasises the commonalities of effective …

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