Chronic Illness Management
“We have moved from understanding what is required to deliver excellent care for individual patients with chronic illnesses to the immense challenge of learning how to implement what we know works at scale: the science of health care delivery.”
Michael Parchman, MD, MPH
Kaiser Permanente Washington Health Research Institute Senior Investigator
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.
“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.
Recent publications on Chronic Illness Management
O'Hare AM, Batten A, Burrows NR, Pavkov ME, Taylor L, Gupta I, Todd-Stenberg J, Maynard C, Rodriguez RA, Murtagh FE, Larson EB, Williams DE. Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis. Am J Kidney Dis. 2012 Apr;59(4):513-22. Epub 2012 Feb 4. PubMed
Von Korff M, Vitiello MV, McCurry SM, Balderson BH, Moore AL, Baker LD, Yarbro P, Saunders K, Keefe FJ, Rybarczyk BD. Group interventions for co-morbid insomnia and osteoarthritis pain in primary care: the lifestyles cluster randomized trial design. Contemp Clin Trials. 2012 Jul;33(4):759-68. Epub 2012 Mar 30. PubMed
Scott RA, Chu AY, Grarup N, Manning AK, Hivert MF, Shungin D, Tonjes A, Yesupriya A, Barnes D, Bouatia-Naji N, Glazer NL, Jackson AU, Kutalik Z, Lagou V, Marek D, Rasmussen-Torvik LJ, Stringham HM, Tanaka T, Aadahl M, Arking DE, Bergmann S, Boerwinkle E, Bonnycastle LL, Bornstein SR, Brunner E, Bumpstead SJ, Brage S, Carlson OD, Chen H, Chen YD, Chines PS, Collins FS, Couper DJ, Dennison EM, Dowling NF, Egan JS, Ekelund U, Erdos MR, Forouhi NG, Fox CS, Goodarzi MO, Grässler J, Gustafsson S, Hallmans G, Hansen T, Hingorani A, Holloway JW, Hu FB, Isomaa B, Jameson KA, Johansson I, Jonsson A, Jørgensen T, Kivimaki M, Kovacs P, Kumari M, Kuusisto J, Laakso M, Lecoeur C, Lévy-Marchal C, Li G, Loos RJ, Lyssenko V, Marmot M, Marques-Vidal P, Morken MA, Müller G, North KE, Pankow JS, Payne F, Prokopenko I, Psaty BM, Renström F, Rice K, Rotter JI, Rybin D, Sandholt CH, Sayer AA, Shrader P, Schwarz PE, Siscovick DS, Stancáková A, Stumvoll M, Teslovich TM, Waeber G, Williams GH, Witte DR, Wood AR, Xie W, Boehnke M, Cooper C, Ferrucci L, Froguel P, Groop L, Kao WH, Vollenweider P, Walker M, Watanabe RM, Pedersen O, Meigs JB, Ingelsson E, Barroso I, Florez JC, Franks PW, Dupuis J, Wareham NJ, Langenberg C. No interactions between previously associated 2-h glucose gene variants and physical activity or BMI on 2-h glucose levels. Diabetes. 2012 May;61(5):1291-6. Epub 2012 Mar 13. PubMed
Kho AN, Hayes MG, Rasmussen-Torvik L, Pacheco JA, Thompson WK, Armstrong LL, Denny JC, Peissig PL, Miller AW, Wei WQ, Bielinski SJ, Chute CG, Leibson CL, Jarvik GP, Crosslin DR, Carlson CS, Newton KM, Wolf WA, Chisholm RL, Lowe WL. Use of diverse electronic medical record systems to identify genetic risk for type 2 diabetes within a genome-wide association study. J Am Med Inform Assoc. 2012 Mar-Apr;19(2):212-8. Epub 2011 Nov 19. PubMed
Noël PH, Lanham HJ, Palmer RF, Leykum LK, Parchman ML. The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams. Health Care Manage Rev. 2013 Jan;38(1):20-8. Epub 2012 Feb 3. PubMed
Researchers in Chronic Illness Management
 Beverly B. Green, MD, MPHSenior Investigator |
 James D. Ralston, MD, MPHSenior Investigator |
 Paula Lozano, MD, MPHSenior Investigator; Director, ACT Center |
 Katie Coleman, MSPHDirector, 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 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 |
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
Healthy findings blog
What works to meet complex needs in diabetes care?
An ACT Center partnership is helping a nonprofit engage patients and provide comprehensive care.
Research
New numbers could help diagnose and treat a common, complex condition
Researchers gain better understanding of polycystic ovary syndrome's impact in U.S.
New findings
Relieving chronic pain with CBT
Cognitive behavioral therapy with yoga-based movement helps with pain for those on long-term opioids.
news release
NIH awards over $15 million in HEAL grants to KPWHRI
Drs. DeBar, Bradley, and Sherman lead projects in initiative to tackle opioid crisis.
opioid research
Opioids may raise risks for serious infections
In Annals editorial Drs. Sascha Dublin and Michael Von Korff advocate more caution in prescribing these medications
Read it in Healthy Findings.
pain management
Six Building Blocks help small rural clinics to manage opioids better
Led by Dr. Michael Parchman, research team uses new way to support small clinics in reducing opioid use in rural Pacific Northwest.
Recent News
Patients may not be telling their doctors what matters to them most
KPWHRI’s VITAL study discovers six domains that people with chronic illness too rarely discuss with their care providers.
Read about it & watch the video in News and Events.
new frontiers
Do mast cells hold the key to chronic and unexplained disease?
Dr. Jennifer McClure reflects on evidence about mast cells as a key to chronic disease, providing new insights for physicians, researchers, and the public.
Land Acknowledgment
Our Seattle offices sit on the occupied land of the Duwamish and by the shared waters of the Coast Salish people, who have been here thousands of years and remain. Learn about practicing land acknowledgment.