There is a large gap between what physicians do for patients with chronic
diseases and what should be done.1 Most physicians
lack the time, information technology, and financial incentives to develop
organized processes to systematically improve the quality of care provided
to these patients.2 During the past decade,
2 main models have emerged to address this “quality chasm” in
outpatient care: disease management and the chronic care model. Early in 2005,
the Center for Medicare & Medicaid Services (CMS) will begin a large disease
management initiative that may profoundly impact patient care and the organization
of physician practice. But few physicians are aware of this initiative, and
in general, neither disease management, nor the chronic care model are easily
understood. Neither model appears in the index of a major collection of essays
on medical group practice published in 2004.3 This
article will describe the CMS initiative, and describe and compare the disease
management and chronic care model models and the effects they may have on
physician practice and on patient care.
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