title: Adapting the chronic care model to treat chronic illness at a free medical clinic.
abstract: This pilot project was designed to determine the feasibility and effectiveness of an adaptation of the chronic care model applied to uninsured patients in a free medical clinic staffed by volunteer physicians. Of the 149 enrolled patients, 117 had hypertension, 91 had diabetes, and 51 had hyperlipidemia. Patients were enrolled in a chronic disease registry from March 1, 2001 through September 30, 2002 at the Salvation Army Free Clinic (SAFC). Two part-time registered nurses served as care managers providing disease-specific management using evidence-based guidelines. Consistent specialty consultation was available via phone, e-mail, or physician visit. Patient self-management was encouraged through collaborative goal setting. There were 40 patients lost to follow-up; 109 completed the study. A clinically significant improvement was obtained in at least one chronic disease for 79 patients. The chronic care model was a useful template for the delivery of effective chronic disease care to a group of uninsured patients at a free medical clinic.
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stroebel
authors.forename: Bonnie
authors.initials: B
authors.lastname: Gloor
authors.forename: Sue
authors.initials: S
authors.lastname: Freytag
authors.forename: Douglas
authors.initials: D
authors.lastname: Riegert-Johnson
authors.forename: Steven A
authors.initials: SA
authors.lastname: Smith
authors.forename: Todd
authors.initials: T
authors.lastname: Huschka
authors.forename: Jim
authors.initials: J
authors.lastname: Naessens
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kottke
mesh_terms: D000328:Adult; D000533:Altruism; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D003151:Community Health Centers / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy; D019468:Disease Management; D005260:Female; D006302:Health Services Research; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008910:Minnesota; D017146:Models, Organizational; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D017664:Uncompensated Care; D014838:Volunteers