Considerations in the design of service specific chronic disease management registers

In Australia chronic diseases currently account for 70% of the total burden of ill health and a correspondingly high proportion of health care expenditure. Even with recent improvements in chronic disease management, there is a significant gap between recommended and actual treatment, care coordination and provision of supports for self management. In Wagner's Chronic Care Model, a chronic disease management register can facilitate individual and population management of chronic diseases and help build partnerships for collaborative diagnosis, treatment planning and care tracking. Various chronic disease management programs currently use chronic disease management registers as a component of their clinical information management systems and there is some evidence that these have contributed to improved chronic disease management. Such registers are relatively uncommon in Australia but may soon proliferate, in part because they have been called for by the National Chronic Disease Strategy. This paper presents suggestions for optimising the utility of chronic disease registries and advancing the agenda for reform in chronic disease management in Australia.