The Struggle To Support Patients' Efforts To Change Their Unhealthy Behavior

PRACTICE Greenhouse Internists, PC. WHO AND WHERE Urban, community-based, five-physician, general internal medicine practice serving about 9,000 economically and racially diverse patients in Philadelphia, Pennsylvania. CORE INNOVATIONS We hired a health educator who trained medical assistants to help patients with chronic diseases set self-management goals. The patients' personal action plans become part of their electronic health records. An interactive Web site encourages patients to share home blood pressure and glucose measurements with physicians. KEY RESULTS In the first six months, 770 diabetic patients made office visits, but only 230, or just under 30 percent, set self-management goals using action plans written down on paper. Few patients have used the Web site to share home management results. An electronic version of the action plan form has not yet been fully implemented. CHALLENGES Incorporating self-management support into patient visits places increased demands on office staff, space, and work flow. Developing a customized electronic action plan form was costly. Fee-for-service payments to the practice are not high enough to cover the salary of a health educator.