A residency clinic chronic condition management quality improvement project

Fam Med. 2007 Feb;39(2):103-11.


Background and objectives: Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics.

Methods: Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress.

Results: Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators.

Conclusions: Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.

MeSH terms

  • Chronic Disease / therapy
  • Disease Management*
  • Family Practice / organization & administration*
  • Humans
  • Internship and Residency*
  • Total Quality Management*
  • United States