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The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office

UCSF Fresno Center for Medical Education and Research, Fresno, Calif

CORRESPONDING AUTHOR: John Zweifler, MD, MPH, Center for Medical Education and Research, UCSF Fresno, 155 N. Fresno St, Suite 326, Fresno, CA 93701, jzweifler{at}fresno.ucsf.edu

Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.

ABSTRACT

Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community. CDM workers should be supported financially by Medicare, Medicaid, and commercial health plans through reimbursements to physicians for units of service, analogous to California’s Comprehensive Perinatal Services Program. Care provided by CDM workers should be standardized, and training requirements should be sufficiently flexible to ensure wide dissemination. CDM workers can potentially improve quality while reducing costs for preventable hospitalizations and emergency department visits, but evaluation at multiple levels is recommended.

Key Words: Chronic disease/therapy • disease management • primary health care • physician’s practice patterns • practice management • quality assurance, health care • quality improvement • office practice issues: office redesign/practice redesign

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