Overview of Chronic Disease Management

Abstract

I want to go into medicine so that I can help large numbers of patients who are suffering from the effects of chronic diseases. I want to be a member of a multidisciplinary disease management team. I want all members of the team to have well-established roles, roles that take advantage of each of our strengths. I want to use information technology in a way that helps provide better care to each of my patients and to the population of patients I care for. I want access to a registry so that I can determine how my patients are doing and so that I can track clinically meaningful outcomes. I want to be able to review the registry data and implement rapid cycle interventions that can be readily monitored and measured, interventions that are linked in cycles and work toward building a safer and more effective health care system. I want to have evidence-based guidelines embedded in the electronic medical record so that I can provide improved point of service care. I want to find ways to be more effective in helping patients learn more about their disease and how to become better at self-management. I want to be comfortable in using motivational interviewing techniques to support the lifestyle changes that are necessary to improve quality of life and outcomes. I want all of my patients to set their own goals and to use an action plan to manage the complications that uniformly occur in chronic disease.