Thomas Jefferson UniversitySidney Kimmel Medical College

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Chronic Care Management (CCI-2)


To study the quality, safety, efficiency and effectiveness of evidence based practice in chronic disease management.



To improve patient care as measured by benchmark quality measures and health outcomes within the context of a Level 3 Patient Centered Medical Home.



The key aim is to evaluate chronic disease management with emphasis on quality improvement, for specific diseases like asthma, diabetes, ischemic heart disease.

Recent Publications:

Careyva B, Salzman B, Plumb E, Kern SB (2012). Patient Perceptions of a Diabetes Group Visit Experience. J Community Med Health Edu 2:135. DOI: 10.4172/jcmhe.1000135.

Reitz J, Sarfaty M, Diamond J, Salzman B. The Effects of a Group Visit Program on Outcomes of Diabetes Care in an Urban Family Practice has now been published in the following paginated issue of Journal of Urban Health: Volume 89, Issue 4 (2012), Page 709-716.


Jeffrey Reitz, Mona Sarfaty, James J. Diamond, Brooke Salzman, Nancy Brisbon, Victor Diaz.  DISH: Evaluation of a diabetes group visit program. Annual Meeting American Public Health Association. October 31, 2012.  San Francisco, California.


Mona Sarfaty, MD, MPH

Brooke Salzman, MD

Victor Diaz, MD

Nancy Brisbon, MD

Janis Bonat, CRNP

Kathleen Hilbert, RN


Mona Sarfaty, MD, MPH