Chronic Illness Management

Research overview

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.

For over 2 decades, KPWHRI scientists have been developing, implementing, and promoting better models of care for chronic illness. Much of this work is led by the institute's Center for Accelerating Care Transformation (ACT Center), which is 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.  

Recent publications on Chronic Illness Management

Ralston JD, Anderson M, Ng J, Bashir A, Ehrlich K, Burns-Hunt D, Cotton M, Hansell L, Hsu C, Hunt H, Karter AJ, Levy SM, Ludman E, Madziwa L, Omura EM, Rogers K, Sevey B, Shaw JAM, Shortreed SM, Singh U, Speight J, Sweeny A, Tschernisch K, Sergei Tschernisch S, Yarborough L. Preventing severe hypoglycemia in adults with type 2 diabetes (PHT2): Design, delivery and evaluation framework for a randomized controlled trial. Contemp Clin Trials. 2024 Jan 20;139:107456. doi: 10.1016/j.cct.2024.107456. [Epub ahead of print]. PubMed

Parchman M, Stefanik-Guizlo K, Shah A, Glaseroff A, Holden E, Bertko J, Zúñiga R. How to identify and support emerging risk Medi-Cal members with complex social and behavioral needs. CHCF. Jan. 2, 2024.

Parchman ML, Stefanik-Guizlo K, Penfold RB, Holden E, Shah AC. Improving diabetes control in a Medicaid managed care population with complex needs. Perm J. 2023 Dec 20:1-6. doi: 10.7812/TPP/23.106. [Epub ahead of print]. PubMed

Wartko PD, Krakauer C, Turner JA, Cook AJ, Boudreau DM, Sullivan MD. STRategies to Improve Pain and Enjoy life (STRIPE): Results of a pragmatic randomized trial of pain coping skills training and opioid medication taper guidance for patients on long-term opioid therapy. Pain. 2023 Dec 1;164(12):2852-2864. doi: 10.1097/j.pain.0000000000002982. Epub 2023 Aug 25. PubMed

Taub C, Gordon KS, Goulet J, Lee A, Mayhew M, Von Korff M, DeBar L, Kerns RD. Graded chronic pain scale revised: Validation in a Veteran sample. Pain Med. 2023 Oct 3;24(10):1169-1175. doi: 10.1093/pm/pnad068. PubMed

Researchers in Chronic Illness Management

Beverly B. Green, MD, MPH

Senior Investigator
206-287-2997
Bev.B.Green@kp.org

Curriculum vitae (CV)

James D. Ralston, MD, MPH

Senior Investigator
206-287-2076
James.D.Ralston@kp.org

Curriculum vitae (CV)

Paula Lozano, MD, MPH

Senior Investigator; Director, ACT Center
206-287-2113
Paula.Lozano@kp.org

Curriculum vitae (CV)

Katie Coleman, MSPH

Director, ACT Center
206-287-2872
Katie.F.Coleman@kp.org

Curriculum vitae (CV)

Gregory E. Simon, MD, MPH

Senior Investigator
206-287-2979
Gregory.E.Simon@kp.org

Curriculum vitae (CV)

Katharine A. Bradley, MD, MPH

Senior Investigator
206-287-2151
Katharine.A.Bradley@kp.org

Curriculum vitae (CV)

Jennifer B. McClure, PhD

Director, Investigative Science
206-287-2737
Jennifer.B.Mcclure@kp.org

Curriculum vitae (CV)

Dori E. Rosenberg, PhD, MPH

Senior Investigator
206-287-2532
Dori.E.Rosenberg@kp.org

Curriculum vitae (CV)

Ben Balderson, PhD

Senior Collaborative Scientist
206-287-2803
Benjamin.H.Balderson@kp.org

Curriculum vitae (CV)

Joseph E. Glass, PhD, MSW

Associate Investigator
206-287-4266
Joseph.E.Glass@kp.org

Curriculum vitae (CV)

Yu-Ru Su, PhD

Associate Biostatistics Investigator
206-287-2948
yuru.su@kp.org

Curriculum vitae (CV)

Chloe Krakauer, PhD

Collaborative Biostatistician
chloe.a.krakauer@kp.org

Curriculum vitae (CV)

Mikael Anne Greenwood-Hickman, MPH

Collaborative Scientist
(206) 287-2908
Mikael.Anne.Greenwood-Hickman@kp.org

Laurel Hansell, MA, MPH

Collaborative Scientist
laurel.d.hansell@kp.org

Curriculum vitae (CV)

Claire Allen, MPH

Manager, Collaborative Science
Claire.L.Allen@kp.org

Curriculum vitae (CV)

Morgan Justice, MA

Collaborative Scientist
Morgan.J.Fuoco@kp.org

Curriculum vitae (CV)

Affiliate Researchers in Chronic Illness Management

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