What do diabetes, back pain, depression, and heart disease have in common? They're among a host of chronic health problems and disabilities that have traditionally received too little attention from health care systems — until serious complications develop. Modern medicine tends to focus on detecting and treating acute problems, leaving fewer resources for the needs of patients with chronic illnesses, which may be less urgent but are equally important.
Our population is aging rapidly, and people with chronic conditions are living longer. Chronic conditions now affect more than 145 million Americans. About half of Americans over 65 — our nation’s fastest-growing segment — have at least 2 chronic conditions. As our need for improved chronic care grows, health care delivery systems are trying to correct the many deficiencies in current management of chronic diseases.
“Much of our work now focuses on finding ways to give organizations the support and tools they need to build high-functioning health care teams that can engage patients, improving the quality and outcomes of their care,” says Michael Parchman, MD, MPH, senior investigator at Kaiser Permanente Washington Health Research Institute (KPWHRI) and a researcher within its Center for Accelerating Care Transformation (ACT Center).
"Meeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice," says Ed Wagner, MD, MPH, founder of the MacColl Center for Health Care Innovation, which joined with Kaiser Permanente Washington’s Learning Health System Program to form the ACT Center.
For over 2 decades, KPWHRI scientists have been developing, implementing, and promoting better models of care for chronic illness. Widely recognized for its refinement and dissemination of the Chronic Care Model, the ACT Center continues to work with providers nationwide to develop strategies and tools for health care systems seeking to improve chronic illness care.
Such resources are then shared globally through active engagement with international organizations developing guidance and care recommendations. Providers worldwide continue to adapt materials such as the ACT Center’s Patient Assessment of Chronic Illness Care and Patient-Centered Medical Home Assessment surveys.
Hylan TR, Von Korff M, Saunders K, Masters E, Palmer RE, Carrell D, Cronkite D, Mardekian J, Gross D. Automated prediction of risk of problem opioid use in a primary care setting. J Pain. 2015 Apr;16(4):380-7. doi: 10.1016/j.jpain.2015.01.011. Epub 2015 Jan 29. PubMed
Bravo PE, Psaty BM, Di Carli MF, Branch KR. Identification of coronary heart disease in asymptomatic individuals with diabetes mellitus: to screen or not to screen. Colomb Med (Cali). 2015 Mar 30;46(1):41-6. eCollection 2015. PubMed
Schmittdiel JA, Desai J, Schroeder EB, Paolino AR, Nichols GA, Lawrence JM, O'Connor PJ, Ohnsorg KA, Newton KM, Steiner JF. Methods for engaging stakeholders in comparative effectiveness research: a patient-centered approach to improving diabetes care. Healthc (Amst). 2015;3(2):80-8. doi: 10.1016/j.hjdsi.2015.02.005. Epub 2015 Mar 13. PubMed
O'Connor PJ, Schmittdiel JA, Pathak RD, Harris RI, Newton KM. Response to comment on O'Connor et al. Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes. Diabetes Care. 2015;38(3):e46. doi: 10.2337/dc14-2928. PubMed
Vazquez-Benitez GV, Desai JR, Xu S, Goodrich GK, Schroeder EB, Nichols GA, Segal J, Kimes TM, Butler MG, Karter AJ, Steiner JF, Newton KM, Morales LS, Pathak RD, Thomas A, Reynolds K, Kirchner HL, Waitzfelder B, Lafata JE, Adibhatla R, Xu Z, O’Connor PJ. Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis. Diabetes Care. 2015 Feb 20. pii: dc141877. [Epub ahead of print].
![]() Beverly B. Green, MD, MPHSenior Investigator |
![]() James D. Ralston, MD, MPHSenior Investigator |
![]() Paula Lozano, MD, MPHSenior Investigator; Director, ACT Center |
![]() Katie Coleman, MSPHDirector, Collaborative Science; Director, ACT Center |
![]() Gregory E. Simon, MD, MPHSenior Investigator |
![]() Katharine A. Bradley, MD, MPHSenior Investigator |
![]() Jennifer B. McClure, PhDDirector, Investigative Science |
![]() Dori E. Rosenberg, PhD, MPHSenior Scientific Investigator |
![]() Ben Balderson, PhDSenior Collaborative Scientist |
![]() Joseph E. Glass, PhD, MSWAssociate Investigator |
![]() Yu-Ru Su, PhDAssociate Biostatistics Investigator |
![]() Chloe Krakauer, PhDCollaborative Biostatistician |
![]() Mikael Anne Greenwood-Hickman, MPHCollaborative Scientist |
![]() Laurel Hansell, MA, MPHCollaborative Scientist |
![]() Claire Allen, MPHManager, Collaborative Science |
![]() Morgan Justice, MACollaborative Scientist |
Laura-Mae Baldwin, MD, MPH
Professor, Department of Family Medicine
University of Washington
Linda LeResche, ScD
Associate Dean for Research, School of Dentistry
Professor, Oral Medicine
University of Washington