Chronic diseases are a tremendous burden to both patients and the health care system. In 2014, 60% of adult Americans had at least one chronic disease or condition, and 42% had multiple diseases (1). Chronic diseases, including heart disease, cancer, chronic lung disease, stroke, Alzheimer’s disease, diabetes, osteoarthritis, and chronic kidney disease, are the leading causes of poor health, long-term disability, and death in the United States (2, 3). Onethird of all deaths in this country are attributable to heart disease or stroke, and every year, more than 1.7 million people receive a diagnosis of cancer (2). During the past several decades, the prevalence of diabetes increased dramatically; in 2015 more than 29 million Americans had diabetes and another 86 million adults had prediabetes, increasing their chance of developing type 2 diabetes (3). Diabetes increases the risk of developing other chronic diseases, including heart disease, stroke, and hypertension, and is the leading cause of end-stage renal failure (4).

Chronic diseases can profoundly reduce quality of life for patients and for their families, affecting enjoyment of life, family relationships, and finances (5). Working can be difficult for people with chronic diseases: rates of absenteeism are higher and income is often lower among people who have a chronic disease compared with people who do not have one. Functional limitations can be distressing, and depression, which can reduce a patient’s ability to cope with pain and worsen the clinical course of disease, is a common complication (6).