Many patients now live with two or more chronic conditions

Due to the growing burden of chronic disease, our work increasingly involves looking for ways to support providers caring for patients who are managing several chronic diseases.  We are collaborating with AHRQ through its Multiple Chronic Conditions Research Network to understand interventions of the most benefit to complex patients.

We offer a proven strategy to help guide health systems change

The Chronic Care Model (CCM) provides an evidence-based framework to guide systems change.  More than 15 years after our development and dissemination of this framework via the Improving Chronic Illness Care program, the CCM continues to be utilized by health care organizations worldwide.

Our tools measure patient and provider experience

Our survey instruments were developed to be practical, readily-available and adaptable tools to help teams improve care for chronic illness -- but they've also been implemented for research purposes around the world.  The Assessment of Chronic Illness Care (ACIC) addresses care at the community, organization, practice and patient levels, and the Patient Assessment of Chronic Illness Care (PACIC) measures specific actions or qualities of care, congruent with the CCM, that patients report they have experienced in the delivery system.

Related Resources

Framework for Regional Healthcare Coalitions

MacColl has developed a practical framework that identifies strategies utilize by regional healthcare coalitions to maximize effectiveness and sustainability. "It Takes a Region: Creating a Framework to Improve Chronic Disease Care" was authored  by Ed Wagner, Katie Coleman, and Brian Austin in 2006 for the California Health Care Foundation.

Aligning Forces for Quality

Our team provides assistance to the 16 communities participating in Aligning Forces for Quality, advising the National Program Office on regional quality improvement (QI) strategies, community drivers for improved healthcare, and how to sustain QI structures and supports once the grant period has ended. MacColl’s  Dr. Ed Wagner has also served on its National Advisory Committee since 2007.

Team Up for Health

The 42-month Team Up for Health initiative, funded by The California HealthCare Foundation, brought patients, their families and clinical teams together to define and test processes leading to better self-management of chronic conditions.

Improving Chronic Illness Care

The Improving Chronic Illness Care website helps health care systems change the care they provide for chronically ill patients, with a special emphasis on underserved populations.  The site is a trusted destination for researchers, clinicians, and other stakeholders seeking evidence-based quality improvement materials.

Evidence on the Chronic Care Model in the New Millenium

MacColl researcher Katie Coleman and colleagues summarized the impact and evidence base accompanying the Chronic Care Model in this paper published in “Health Affairs”.

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