JD

Chronic Condition Registry

Disease registry management — 9 active chronic condition programs tracking 8,432 members

Total Registry Members
6,284
↑ 3.2% MoM
74.5% of total population
Avg Compliance Rate
76.4%
↑ 2.8% QoQ
Care plan adherence
Active Conditions
9
Disease programs active
Avg Risk Score
2.41
↑ 0.18 YoY
RAF weighted average
Disease Registry — All Conditions
Condition ICD-10 Range Enrolled Avg Risk Score Compliance % Outcome Score Status Actions
Type 2 Diabetes E11.x 1,247 2.84
72.4%
 74.1% Active
Hypertension I10-I16 2,134 1.94
79.2%
 81.3% Active
Congestive Heart Failure I50.x 287 3.21
68.4%
 70.2% Active
COPD J44.x 341 2.97
71.8%
 68.9% Active
Chronic Kidney Disease N18.x 412 3.08
74.6%
 72.8% Active
Major Depressive Disorder F32–F33 534 2.12
63.7%
 61.4% Active
Atrial Fibrillation I48.x 267 3.14
82.1%
 84.7% Active
Obesity E66.x 743 1.87
58.4%
 56.9% Active
Rheumatoid Arthritis M05–M06 319 2.34
77.8%
 79.2% Active

Registry Quality Measures

Care Plan Completion
84.2%
Annual Visit Rate
91.7%
ED Visit Rate/1000
187
30-Day Readmission
14.3%
Page Guide

The Chronic Condition Registry tracks members enrolled in disease management programs. Each row represents one condition with aggregated metrics across all enrolled members.

Click "Drill-down" on any condition to view individual member lists, care plan status, last encounter date, and quality measure compliance at the member level.

Use "Add to Registry" to enroll members in a disease program manually or via bulk import. "Remove from Registry" archives members who no longer meet enrollment criteria.

Compliance % tracks care plan adherence (appointments attended, screenings completed). Outcome Score is a composite of clinical indicators specific to each condition.