Many patients now live with two or more chronic conditions

Due to the growing burden of chronic disease, our work increasingly involves looking for ways to support providers caring for patients who are managing several chronic diseases.  We are collaborating with AHRQ through its Multiple Chronic Conditions Research Network to understand interventions of the most benefit to complex patients.

We offer a proven strategy to help guide health systems change

The Chronic Care Model (CCM) provides an evidence-based framework to guide systems change.  More than 15 years after our development and dissemination of this framework via the Improving Chronic Illness Care program, the CCM continues to be utilized by health care organizations worldwide.

Our tools measure patient and provider experience

Our survey instruments were developed to be practical, readily-available and adaptable tools to help teams improve care for chronic illness -- but they've also been implemented for research purposes around the world.  The Assessment of Chronic Illness Care (ACIC) addresses care at the community, organization, practice and patient levels, and the Patient Assessment of Chronic Illness Care (PACIC) measures specific actions or qualities of care, congruent with the CCM, that patients report they have experienced in the delivery system.

Related Resources

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions. Rosie Ferris, MPH, Caroline Blaum, MD, MS, Eliza Kiwak, BA, Janet Austin, PhD, Jessica Esterson, MPH, Gene Harkless, DNSc, APRN, FAANP, CNL, Gary Oftedahl, MD, Michael Parchman, MD, MPH, Peter H. Van Ness, PhD, MPH, and Mary E. Tinetti, MD.

A First Step on the Journey to High-Quality Chronic Illness Care

A First Step on the Journey to High-Quality Chronic Illness Care. Wagner, EH. Healthc Pap. 2016;15 Spec No:62-5; discussion 97-123.    The Atlantic Healthcare Collaboration conducted a quality improvement initiative to improve chronic disease prevention and management for the four Atlantic provinces and their regional health authorities. Leaders and front-line teams carried out a range of projects, each suited to the needs of that region.

Taking Action on Overuse Action Planning Framework

Taking Action on Overuse Action Planning Framework

The Taking Action on Overuse Action Planning Framework (formerly Supporting Provider Engagement to Reduce Low-Value Care) is a promising approach to engage healthcare providers and care teams in undertaking the difficult work of reducing low-value, unnecessary care. The MacColl Center for Health Care Innovation developed this framework with the support of the Robert Wood Johnson Foundation (RWJF).

Taking action on overuse: Creating the culture for change

Our team has spent the past two years developing an approach for engaging providers in reducing medical overuse. It focuses on the real-world aspects of implementing change, centering on the conditions and practices that help providers transform established practice patterns. You can read the story of the Taking Action on Overuse framework in Healthcare: The Journal of Delivery Science and Innovation.

OPCA Alternative Payment & Advanced Care Model Learning Exchange Summary

OPCA APACM Learning Exchange report

Since 2010, the Oregon Primary Care Association (OPCA) has been leading the development and implementation of an Alternative Payment Methodology (APM), in partnership with Oregon’s state Medicaid office. The purpose of the APM is to provide participating clinics with a payment approach that is detached from the face-to-face provider visit, allowing for much greater flexibility in transforming the care model to support population health.

How do we learn about improving health care: a call for a new epistemological paradigm

"How do we learn about improving health care: a call for a new epistemological paradigm" is a new publication co-authored by MacColl's Director Michael Parchman, MD and our colleague Rashad Massoud, MD, MPH, FACP, Director of the USAID Applying Science to Strengthen and Improve Systems Project and its predecessor, the USAID Health Care Improvement Project. 

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