title: Managing chronic illness: physician practices increased the use of care management and medical home processes.
abstract: The effective management of patients with chronic illnesses is critical to bending the curve of health care spending in the United States and is a crucial test for health care reform. In this article we used data from three national surveys of physician practices between 2006 and 2013 to determine the extent to which practices of all sizes have increased their use of evidence-based care management processes associated with patient-centered medical homes for patients with asthma, congestive heart failure, depression, and diabetes. We found relatively large increases over time in the overall use of these processes for small and medium-size practices as well as for large practices. However, the large practices used fewer than half of the recommended processes, on average. We also identified the individual processes whose use increased the most and show that greater use of care management processes is positively associated with public reporting of patient experience and clinical quality and with pay-for-performance.
authors.affiliation: James A. Wiley is a professor at the Institute for Health Policy Studies, University of California, San Francisco (UCSF).
authors.forename: James A
authors.initials: JA
authors.lastname: Wiley
authors.affiliation: Diane R. Rittenhouse is an associate professor in the Department of Family and Community Medicine, UCSF.
authors.forename: Diane R
authors.initials: DR
authors.lastname: Rittenhouse
authors.affiliation: Stephen M. Shortell (shortell@berkeley.edu) is the Blue Cross of California Distinguished Professor of Health Policy and Management and faculty director of the Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health; and a professor of organizational behavior, Haas School of Business, all at the University of California, Berkeley.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.affiliation: Lawrence P. Casalino is the Livingston Farrand Professor in the Department of Public Health, Weill Cornell Medical College, in New York City.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.affiliation: Patricia P. Ramsay is a research specialist and administrative director in CHOIR, School of Public Health, UC Berkeley.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Ramsay
authors.affiliation: Salma Bibi is a research analyst in the School of Public Health, UC Berkeley.
authors.forename: Salma
authors.initials: S
authors.lastname: Bibi
authors.affiliation: Andrew M. Ryan is an associate professor of public health at the University of Michigan, in Ann Arbor.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.affiliation: Kennon R. Copeland is senior vice president and director of statistics and methodology at NORC at the University of Chicago, in Bethesda, Maryland.
authors.forename: Kennon R
authors.initials: KR
authors.lastname: Copeland
authors.affiliation: Jeffrey A. Alexander is a professor emeritus at the University of Michigan, in Ann Arbor.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
mesh_terms: D001249:Asthma / Q000191:economics / Q000628:therapy; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D003363:Cost Control / Q000191:economics / Q000639:trends; D003362:Cost-Benefit Analysis / Q000191:economics / Q000639:trends; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy; D019317:Evidence-Based Medicine / Q000191:economics / Q000639:trends; D018166:Health Care Reform / Q000191:economics / Q000639:trends; D019538:Health Care Surveys; D006333:Heart Failure / Q000191:economics / Q000628:therapy; D006801:Humans; D010346:Patient Care Management / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends*; D018802:Patient-Centered Care / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D011785:Quality Assurance, Health Care / Q000191:economics; D012052:Reimbursement, Incentive / Q000191:economics / Q000639:trends; D014481:United States; D014600:Utilization Review / Q000639:trends
keywords: Chronic Care; Evidence-Based Medicine; Medicine/Clinical Issues; Organization and Delivery of Care; Quality Of Care