Chronic Illness Management

Research overview

What do diabetes, back pain, depression, and heart disease have in common? They're among a host of chronic health problems and disabilities that have traditionally received too little attention from health care systems — until serious complications develop. Modern medicine tends to focus on detecting and treating acute problems, leaving fewer resources for the needs of patients with chronic illnesses, which may be less urgent but are equally important.

Our population is aging rapidly, and people with chronic conditions are living longer. Chronic conditions now affect more than 145 million Americans. About half of Americans over 65 — our nation’s fastest-growing segment — have at least 2 chronic conditions. As our need for improved chronic care grows, health care delivery systems are trying to correct the many deficiencies in current management of chronic diseases.

For over 2 decades, KPWHRI scientists have been developing, implementing, and promoting better models of care for chronic illness. Much of this work is led by the institute's Center for Accelerating Care Transformation (ACT Center), which is widely recognized for its refinement and dissemination of the Chronic Care Model. The ACT Center continues to work with providers nationwide to develop strategies and tools for health care systems seeking to improve chronic illness care. 

Such resources are then shared globally through active engagement with international organizations developing guidance and care recommendations. Providers worldwide continue to adapt materials such as the ACT Center’s Patient Assessment of Chronic Illness Care and Patient-Centered Medical Home Assessment surveys.  

Recent publications on Chronic Illness Management

Schmittdiel JA, Desai J, Schroeder EB, Paolino AR, Nichols GA, Lawrence JM, O'Connor PJ, Ohnsorg KA, Newton KM, Steiner JF. Methods for engaging stakeholders in comparative effectiveness research: a patient-centered approach to improving diabetes care. Healthc (Amst). 2015;3(2):80-8. doi: 10.1016/j.hjdsi.2015.02.005. Epub 2015 Mar 13.  PubMed

O'Connor PJ, Schmittdiel JA, Pathak RD, Harris RI, Newton KM. Response to comment on O'Connor et al. Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes. Diabetes Care. 2015;38(3):e46. doi: 10.2337/dc14-2928.  PubMed

Amtmann D, Askew RL, Kim J, Chung H, Ehde DM, Bombardier CH, Kraft GH, Jones SM, Johnson KL. Pain affects depression through anxiety, fatigue, and sleep in Multiple Sclerosis. Rehabil Psychol. 2015 Feb;60(1):81-90. doi: 10.1037/rep0000027. Epub 2015 Jan 19. PubMed

Saberi P, Catz SL, Leyden WA, Stewart C, Ralston JD, Horberg MA, Grothaus L, Silverberg MJ. Antiretroviral therapy adherence and use of an electronic shared medical record among people living with HIV. AIDS Behav. 2015 Jan 9 [Epub ahead of print]. PubMed

Wessel J, Chu AY, Willems SM, Wang S, Yaghootkar H, Brody JA, Dauriz M, Hivert MF, Raghavan S, Lipovich L, Hidalgo B, Fox K, Huffman JE, An P, Lu Y, Rasmussen-Torvik LJ, Grarup N, Ehm MG, Li L, Baldridge AS, Stancáková A, Abrol R, Besse C, Boland A, Bork-Jensen J, Fornage M, Freitag DF, Garcia ME, Guo X, Hara K, Isaacs A, Jakobsdottir J, Lange LA, Layton JC, Li M, Hua Zhao J, Meidtner K, Morrison AC, Nalls MA, Peters MJ, Sabater-Lleal M, Schurmann C, Silveira A, Smith AV, Southam L, Stoiber MH, Strawbridge RJ, Taylor KD, Varga TV, Allin KH, Amin N, Aponte JL, Aung T, Barbieri C, Bihlmeyer NA, Boehnke M, Bombieri C, Bowden DW, Burns SM, Chen Y, Chen YD, Cheng CY, Correa A, Czajkowski J, Dehghan A, Ehret GB, Eiriksdottir G, Escher SA, Farmaki AE, Frånberg M, Gambaro G, Giulianini F, Goddard WA, Goel A, Gottesman O, Grove ML, Gustafsson S, Hai Y, Hallmans G, Heo J, Hoffmann P, Ikram MK, Jensen RA, Jørgensen ME, Jørgensen T, Karaleftheri M, Khor CC, Kirkpatrick A, Kraja AT, Kuusisto J, Lange EM, Lee IT, Lee WJ, Leong A, Liao J, Liu C, Liu Y, Lindgren CM, Linneberg A, Malerba G, Mamakou V, Marouli E, Maruthur NM, Matchan A, McKean-Cowdin R, McLeod O, Metcalf GA, Mohlke KL, Muzny DM, Ntalla I, Palmer ND, Pasko D, Peter A, Rayner NW, Renström F, Rice K, Sala CF, Sennblad B, Serafetinidis I, Smith JA, Soranzo N, Speliotes EK, Stahl EA, Stirrups K, Tentolouris N, Thanopoulou A, Torres M, Traglia M, Tsafantakis E, Javad S, Yanek LR, Zengini E, Becker DM, Bis JC, Brown JB, Adrienne Cupples L, Hansen T, Ingelsson E, Karter AJ, Lorenzo C, Mathias RA, Norris JM, Peloso GM, Sheu WH, Toniolo D, Vaidya D, Varma R, Wagenknecht LE, Boeing H, Bottinger EP, Dedoussis G, Deloukas P, Ferrannini E, Franco OH, Franks PW, Gibbs RA, Gudnason V, Hamsten A, Harris TB, Hattersley AT, Hayward C, Hofman A, Jansson JH, Langenberg C, Launer LJ, Levy D, Oostra BA, O'Donnell CJ, O'Rahilly S, Padmanabhan S, Pankow JS, Polasek O, Province MA, Rich SS, Ridker PM, Rudan I, Schulze MB, Smith BH, Uitterlinden AG, Walker M, Watkins H, Wong TY, Zeggini E; EPIC-InterAct Consortium, Laakso M, Borecki IB, Chasman DI, Pedersen O, Psaty BM, Shyong Tai E, van Duijn CM, Wareham NJ, Waterworth DM, Boerwinkle E, Linda Kao WH, Florez JC, Loos RJ, Wilson JG, Frayling TM, Siscovick DS, Dupuis J, Rotter JI, Meigs JB, Scott RA, Goodarzi MO; EPIC-InterAct Consortium. Low-frequency and rare exome chip variants associate with fasting glucose and type 2 diabetes susceptibility.  Nat Commun. 2015 Jan 29;6:5897. doi: 10.1038/ncomms6897.  PubMed

Researchers in Chronic Illness Management

Beverly B. Green, MD, MPH

Senior Investigator
206-287-2997
Bev.B.Green@kp.org

Curriculum vitae (CV)

James D. Ralston, MD, MPH

Senior Investigator
206-287-2076
James.D.Ralston@kp.org

Curriculum vitae (CV)

Paula Lozano, MD, MPH

Senior Investigator; Director, ACT Center
206-287-2113
Paula.Lozano@kp.org

Curriculum vitae (CV)

Katie Coleman, MSPH

Director, ACT Center
206-287-2872
Katie.F.Coleman@kp.org

Curriculum vitae (CV)

Gregory E. Simon, MD, MPH

Senior Investigator
206-287-2979
Gregory.E.Simon@kp.org

Curriculum vitae (CV)

Katharine A. Bradley, MD, MPH

Senior Investigator
206-287-2151
Katharine.A.Bradley@kp.org

Curriculum vitae (CV)

Jennifer B. McClure, PhD

Director, Investigative Science
206-287-2737
Jennifer.B.Mcclure@kp.org

Curriculum vitae (CV)

Dori E. Rosenberg, PhD, MPH

Senior Investigator
206-287-2532
Dori.E.Rosenberg@kp.org

Curriculum vitae (CV)

Ben Balderson, PhD

Senior Collaborative Scientist
206-287-2803
Benjamin.H.Balderson@kp.org

Curriculum vitae (CV)

Joseph E. Glass, PhD, MSW

Associate Investigator
206-287-4266
Joseph.E.Glass@kp.org

Curriculum vitae (CV)

Yu-Ru Su, PhD

Associate Biostatistics Investigator
206-287-2948
yuru.su@kp.org

Curriculum vitae (CV)

Chloe Krakauer, PhD

Collaborative Biostatistician
chloe.a.krakauer@kp.org

Curriculum vitae (CV)

Mikael Anne Greenwood-Hickman, MPH

Collaborative Scientist
(206) 287-2908
Mikael.Anne.Greenwood-Hickman@kp.org

Laurel Hansell, MA, MPH

Collaborative Scientist
laurel.d.hansell@kp.org

Curriculum vitae (CV)

Claire Allen, MPH

Manager, Collaborative Science
Claire.L.Allen@kp.org

Curriculum vitae (CV)

Morgan Justice, MA

Collaborative Scientist
Morgan.J.Fuoco@kp.org

Curriculum vitae (CV)

Affiliate Researchers in Chronic Illness Management

Laura-Mae Baldwin, MD, MPH 
Professor, Department of Family Medicine
University of Washington

Linda LeResche, ScD
Associate Dean for Research, School of Dentistry
Professor, Oral Medicine
University of Washington