Most presentations on the Chronic Care Model have left me feeling vaguely depressed. The vision of excellent, integrated, patient-centered chronic care was enticing, but the barriers to implementation seemed so formidable that the vision shimmered like a distant mirage. “Escaping the Tyranny of the Urgent by Delivering Planned Care,” by L. Gordon Moore, MD, demonstrates that the vision is no mirage. Moore shows how he has implemented major aspects of the model in his solo practice. If he can do it, so can you.
Not that it's easy. Chances are good that your practice is not designed or equipped to deliver good chronic disease care, let alone planned care in general, and the health care system in which you practice just makes the job harder. In general, neither well-intentioned primary care practices nor fancy, carve-out disease management programs produce the results we would hope for. Primary care at least has potential, though.1
The pieces Moore has put together include an electronic health record (EHR) system, a patient registry, a set of clinical guidelines, electronic support for prescribing, online access to evidence-based recommendations and patient information. The glue he has used to hold the pieces together is practice redesign: He has implemented open access; team-based care; continual measurement, improvement and simplification of processes; and population-based care.
Yes, the prospect is still daunting. That's a lot of pieces to put together, a lot of opportunities for trouble. The good news, though, is that planned care – and practice improvement in general – is not monolithic. It's available disassembled, and it can be implemented stepwise, one piece at a time. While it's important to start with the end in mind, there's no reason you can't implement one or two elements and derive the benefits they have to offer while you're working on the next piece. And while some pieces are expensive – an EHR, for example – others are essentially free, so there's something for every budget. Think about it. Maybe it's time to get a plan and start building a renewed practice one piece at a time.