Abstract: A chronic disease outcomes, communication, and education system used in connection with a patient is disclosed. The system comprises a database for storing a plurality of patient data entries, each of the patient data entries including personal information of a patient and a guideline concerning the patient's care, the guideline including a default test value associated with monitoring the chronic disease, a user interface for entering patient entries for storage in the database and queries related to patient monitoring, communication and education, and a processor for retrieving the patient data entries from the database in response to the queries from the user interface and storing the patient data entries in the database. The processor provides patient and population outcomes analysis according to an algorithm.

Abstract: A system for monitoring a chronic disease is disclosed. The monitor includes a database for storing a plurality of patient data entries and sorts the patient data entries according to whether a test threshold is crossed. Each of the patient data entries includes personal information of a patient and a set of guidelines concerning the patient's care. The guideline represents a plurality of rules concerning a patient's care derived from accepted tests used to monitor the disease represented in an algorithm. A processor separates the patient entries designated by the user according to the test thresholds, such as for HbA1c, lipids, liver enzyme and microalbumin, for the disease of diabetes.