An organized approach to chronic disease care.

S T U A R T B R A D F O R D A s primary care physicians, we spend the majority of our time caring for patients with chronic diseases, but data suggest we achieve the standard of care for chronic diseases and preventive care only 50 percent to 60 percent of the time. We should not be surprised by these results. It takes time to measure and monitor our patients’ progress, and time is something we have far too little of. Years of declining payment have necessitated that we see more patients in less time. Having adequate time to listen and examine the patient is now a luxury. Proper documentation and coding, past record review, and testing follow-up consume most of our time between visits. Four years ago our family medicine residency program decided to look closely at our chronic disease care performance. We provide 32,000 patient visits per year at our urban Milwaukee practice, where most patients are underserved and many have chronic medical conditions. When we developed functional patient registries and were able to produce the data we needed for our assessment, we realized that our performance was no better than average. We knew we could do better, but not without an organized, team-based approach. The outdated