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Organizational Technologies of Chronic Disease Management Programs in Large Rural Multispecialty Group Practice Systems

Gamm, Larry PhD; Bolin, Jane Nelson PhD, JD, RN; Kash, Bita A. MBA, FACHE

Journal of Ambulatory Care Management: July-September 2005 - Volume 28 - Issue 3 - p 210–221

Four large rural multispecialty group practice systems employ a mix of organizational technologies to provide chronic disease management with measurable impacts on their patient populations and costs. Four technologies—administrative, clinical, information, and social—are proposed as key dimensions for examining disease management programs. The benefits of disease management are recognized by these systems despite marked variability in the organization of the programs. Committees spanning health plans and clinics in the 4 systems and electronic medical records and/or other disease management information systems are important coordinating mechanisms. Increased reliance on nurses for patient education and care coordination in all 4 systems reflects significant extension of clinical and social technologies in the management of patient care. The promise of disease management as offered by these systems and other auspices are considered.

Department of Health Policy and Management, School of Rural Public Health, Health Science Center, Texas A&M University System, College Station.

Corresponding author: Larry Gamm, PhD, Southwest Rural Health Research Center, Texas A&M University Health Science Center, 3000 Briarcrest Dr, Suite 300, Bryan, TX 77802 (e-mail:

The authors and the Southwest Rural Health Research Center gratefully acknowledge grant support for the Chronic Disease Management in Rural Areas project from the Federal Office of Rural Healthy Policy (ORHP) and the Health Resources and Services Administration (HRSA) through Grant #5-U1C-RH00033. The views expressed in this article do not necessarily reflect the views of the sponsoring organization or the authors' home institutions.

© 2005 Lippincott Williams & Wilkins, Inc.