1. La gestión de los cuidados a enfermos crónicos: experiencias en EEUU Caring for people with chronic illness: lessons from the United States Thomas Bodenheimer, MD Professor, Department of Family & Community Medicine University of California, San Francisco, USA

2. % of People in US with a Chronic Illness 45% 57% 1 Chronic Illness 43% 2 or more chronic illnesses Hoffman et al, JAMA 1996;276:1473 56 million people Spain: 47 million

3. Per capita health expenditures, 2008 OECD, 2010 9% of GDP 16% of GDP

4. Average per capita spending by number of chronic conditions (2004) Anderson, “Chronic conditions” Johns Hopkins, 2007

7. Percent of visits that are primary care 2006 Chronic care is a primary care problem

9. Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Functional and Clinical Outcomes Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources and Policies Community Health Care Organization Chronic Care Model

15. It all starts with teams

18. Physician/MA teamlet Patient panel Physician/MA/ teamlet Patient panel Nurse, social worker, pharmacist, health educator, nutritionist, receptionist Patient panel Physician/MA teamlet 1 team, 3 teamlets

20. Physician, MA, Nurse Patient panel Physician Patient panel MA Tasks Yo model Nosotros model Nurse Tasks

30. Physician and health coach (promotora) meet with patient

35. Health coach doing medication education

37. Average per capita spending by number of chronic conditions (2004) Anderson, “Chronic conditions” Johns Hopkins, 2007

47. Patients get “tarjeta de visita” with names of their teamlet

48. Teamlet discussing a patient