Improving Chronic Disease Care for Populations with Limited Health Literacy

Dean Schillinger, M.D.

The problem with communication is the assumption that it has occurred.

—George Bernard Shaw


Chronic disease management is one of the major challenges facing health-care systems and patients in industrialized nations. Nearly three-quarters of all health-care resources are devoted to the treatment of chronic diseases, and nearly one-half of the U.S. population has one or more chronic condition (Institute for Health and Aging, 1996). The collaboration between the system of care, providers, patients, and the community to provide the best health outcomes adds a layer of complexity to the delivery of health care to individuals with chronic disease. Effective disease management is based on systematic, interactive communication between patients and the providers and health system with whom they interact (Norris et al., 2002a, b; Von Korff et al., 1997), all occurring in the context of a community whose resources meet patients’ needs (Wagner, 1995).

This paper uses the definition of disease management provided by the Task Force on Community Preventive Services, a nonfederal Task Force convened in 1996 by the Department of Health and Human Services (HHS) to provide leadership in the evaluation of community, population, and health-care system strategies to address a variety of public health and health promotion topics, and appointed by the Director of the Centers for Disease Control and Prevention (Norris et al., 2002a, b). Disease management is an organized, proactive, multicomponent approach to health-care delivery that involves all members of a population with a specific disease, is focused on the spectrum of the disease and its complications (including the prevention of co-morbid conditions), and is integrated across the relevant aspects of the delivery system.

The last few decades have seen tremendous advances in the care of chronic conditions, including an array of new therapeutic options, risk-factor modification for secondary prevention of co-morbid conditions, the availability of home monitoring tools, and the growth of disease manage-

The research reported herein was supported, in part, through grants from the National Center for Research Resources (K-23 RR16539), the Soros Open Society Institute, and The Commonwealth Fund.

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