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- Read the Grantee Story: Making Health Systems Work for People With Chronic Conditions
The Instruction Manual for Designing Health Care Delivery in Battle Creek, Mich.
Improving Chronic Illness Care
Field of Work: Implementing the Chronic Care Model
Problem Synopsis: Even before the 2008 recession that hobbled the automobile industry on which it is so dependent, Battle Creek, Mich., a town of 52,000, had an anemic economy and depressing health statistics. In Calhoun County, where Battle Creek is located, 10 percent of adults have diabetes, with an additional 40 percent pre-diabetic. In addition, more than 70 percent of residents in Calhoun County are overweight or obese.
Synopsis of the Work: In 2007, Integrated Health Partners, a group of some 170 affiliated physicians in the Battle Creek, launched a learning collaborative with local physicians and practice teams interested in implementing the Chronic Care Model. Subsequently, the work expanded to include people all along the continuum of care for chronically ill patients: physicians in solo practice, discharge planners in hospitals, employers, social service agency workers and others.
Key Findings/Results: By the end of 2010, the effort was beginning to show results in improved patient outcomes. Some 25 percent of diabetes patients and nearly 50 percent of cardiovascular disease patients had physicians who had participated in a Chronic Care Model learning collaborative.
Improving Chronic Illness Care Sidebars
Stories from the RWJF national program, Improving Chronic Illness Care
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- Evidence on the Chronic Care Model in the New Millennium
- Academia, Chronic Care, and the Future of Primary Care
- Can a Chronic Care Model Collaborative Reduce Heart Disease Risk in Patients with Diabetes
- Linking a Motivational Interviewing Curriculum to the Chronic Care Model
- Chronic Care: Making the Case for Ongoing Care
- Implementation of a Chronic Illness Model for Diabetes Care in a Family Medicine Residency Program
- Developing Measures of Educational Change for Academic Health Care Teams Implementing the Chronic Care Model in Teaching Practices