Improving Care for Chronic Conditions
Definition
The number of chronic conditions patients in the
registry with documented self-management goals in the last 12 months, divided by the total number of patients with that specific chronic condition in the registry. Multiply by 100 to get the percentage.
Goal
Greater than 70 percent of patients have documented self-management goals.
Data Collection Plan
On the last workday of the month, search the registry for all patients with a diagnosis of the specific chronic condition (e.g., diabetes mellitus, asthma, depression) who have documented self-management goals set with a clinician in the last 12 months. At the same time, count the total number of patients with a diagnosis of the specific chronic condition (e.g., diabetes mellitus, asthma, depression.)
Sample Graph
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