Learn how coaching is being deployed in the clinical setting from LA Net, a practice-based research network, and the San Francisco Health Plan, a Medi-Cal managed care plan.

Eight organizations with experience caring for medically complex patients participated in this yearlong collaborative that shared and tested methods for producing better outcomes at lower cost.

Identifying high-risk patients and matching them with the most appropriate interventions is a challenge. Risk stratification tools can help, but they have limitations.

CHCF invests in Asthmapolis, a technology-based innovation that combines sensors with asthma inhalers to provide tailored information through mobile phones to people living with asthma.

Chronic disease management systems can help track multiple chronic conditions. In 2008, six philanthropies launched this initiative to enable community clinics adopt CDMS technology.

This report features lessons on spreading better ideas in chronic disease care from the California Improvement Network. Topics include establishing a strategy, creating an effective social system, measuring effectiveness, and providing feedback.

Learn how leaders from SMMC are transforming primary care within a public health delivery system. The presentation highlights their Innovative Care Clinic, a robust primary care model that is now beginning to demonstrate meaningful improvements in care.

A flexible evidence-based approach to treating depression in the primary care setting, the IMPACT model has been implemented in a range of settings.

This project explored whether non-diabetic high school students could serve as self-management coaches for diabetic family members after learning about the disease and developing communication and coaching skills in a structured school program.

"Care Management Plus" focuses on improving the quality of care for seniors and patients with chronic illnesses.

Self-management support for patients with chronic illness is a routine function of clinical care in many primary care organizations. This report describes a number of models that have been successful in involving these patients in a well-planned and efficient way.

From 2006 to 2008, the CACCC worked with 19 residency training teams from nine California academic medical centers to make changes to their clinical and education programs, aiming to reflect a greater focus on chronic disease.

These reports are designed to help counties and local health systems identify regions in California with high rates of chronic disease. The analysis includes exhibits, maps, and statistics related to specific conditions, including hypertension, diabetes, and asthma.

To spur the adoption of quality improvement methods and the use of electronic data by public hospital systems to improve diabetes care (and ultimately other chronic disease care), CHCF allocated up to $1.2 million for this two-year project.

Emerging trends and effective models in chronic disease care were shared at networking conferences in 2005 and 2008 in San Francisco. See the agendas, speakers, and presentation materials.