Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCM's effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes.

As the patient-centered medical home model emerges as a key vehicle to improve the quality of health care and to control costs, the experience of Seattle-based Group Health Cooperative with its medical home pilot takes on added importance. This paper examines the effects of the medical home prototype on patients' experiences, quality, burnout of clinicians, and total costs at twenty-one to twenty-four months after implementation. The results show improvements in patients' experiences, quality, and clinician burnout through two years. Compared to other Group Health clinics, patients in the medical home experienced 29 percent fewer emergency visits and 6 percent fewer hospitalizations. We estimate total savings of $10.3 per patient per month twenty-one months into the pilot. We offer an operational blueprint and policy recommendations for adoption in other health care settings.

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In the past 10 years, a wide spectrum of chronic care improvement interventions has been tried and evaluated to improve health outcomes and reduce costs for chronically ill individuals. On one end of the spectrum are disease-management interventions-often organized by commercial vendors-that work with patients but do little to engage medical practice. On the other end are quality-improvement efforts aimed at redesigning the organization and delivery of primary care and better supporting patient self-management. This qualitative review finds that carve-out disease management interventions that target only patients may be less effective than those that also work to redesign care delivery. Imprecise nomenclature and poor study design methodology limit quantitative analysis. More innovation and research are needed to understand how disease-management components can be more meaningfully embedded within practice to improve patient care.

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Patients enjoy their involvement in community-based teaching and perceive themselves as making a valuable contribution. The findings of the research will be reassuring for doctors who presently are involved and those who plan to be involved in the future. Doctors need to be aware of the possible shifts in the doctor-patient relationship when actively seeking patients' help in the teaching.

The proposed federal "meaningful use" criteria for electronic health records include the direct engagement of patients in their care. In this study, we sought to describe the adoption and use of online services linked to the electronic health record at Group Health Cooperative. By August 2009, six years after the introduction of these services, 30 percent of outpatient "encounters" were actually conducted through secure electronic messaging. Meanwhile, 10 percent of enrollees reviewed medical test results online, while 10 percent went online to request medication refills. These results highlight the need to measure the patient experience as part of meaningful use and to enact policies supporting online and phone communication by patients and providers.

Pay-for-performance programs are being developed to improve quality of care despite limited empirical evidence demonstrating their effectiveness, especially in underserved communities. Using data on 1,166 patients treated by 46 primary care physicians, this paper examines the effect of an innovative pay-for-performance program implemented in 2004 at the nation's largest federally qualified health center on hemoglobin A1c (HbA1c) testing and HbA1c scores. Univariate analysis and logistic regression results show that the pay-for-performance program significantly increased the likelihood that patients received two HbA1c tests per year as recommended by the American Diabetes Association. Ordinary least squares (OLS) regression results reveal that physicians' baseline performance was positively related to performance after program implementation. Finally, OLS regression results suggest that the program did not contribute to improved blood sugar control. The pay-for-performance program appeared to improve compliance with HbA1c testing recommendations, but a more comprehensive strategy, including increased patient support, may be necessary to improve health outcomes in disadvantaged populations.