Transcript Applying the Chronic Care Model across Multiple Conditions

Applying the Chronic Care Model across multiple conditions:
A planned care quality improvement initiative in the Indian Health System
Cindy Hupke, RN, MBA 1; Ty Reidhead, MD2; Bruce Finke, MD2; Pat Lundgren, RN, EdD2; Lisa Dolan-Branton,
2
1
1
1
1
1
RN ; Gerald Langley, MS ; Tracy Jacobs, RN ; Lindsay Hunt, BA ; Kedar Mate, MD ; Don Goldmann, MD
• Improvement is guided by
measurement in four domains:
- preventive care
- management of chronic
conditions
- patient experience of care
- cost of care
80
70
60
50
40
20
• Data from sites were tracked using web-based
monthly reporting tools on the extranet and analyzed
using weighted averages in Microsoft Excel.
Weighted Average Cancer_Bundle: IPC
75
• Minimal data on cost of
changes in the system was
obtained.
70
65
Percent
60
55
50
Conclusions
45
40
35
• Sites shared learning through virtual meetings, a
mutual listserv, and extranet.
- Intake screening bundles: alcohol use, depression, body
mass index, blood pressure, domestic violence and tobacco
use
- Cancer screening bundles: screening for colorectal, cervical
and breast cancer
- Diabetes comprehensive measures includes key processes
of care
• There was no control group
to compare findings.
30
- organizational and community assessment tools
- process flow diagrams
- rapid cycle improvement methods
(plan-do-study-act cycles)
• Composite measures were used:
• Participating sites self
selected to participate and
were motivated to improve.
Weighted Average Intake Bundle: IPC
F07
M
-0
7
A
-0
7
M
-0
7
J07
J07
A
-0
7
S
-0
7
O
-0
7
N
-0
7
D
-0
7
J08
F08
M
-0
8
A
-0
8
M
-0
8
J08
J08
A
-0
8
S
-0
8
O
-0
8
N
-0
8
D
-0
8
J09
• From March 2007 to August 2008, microsystems (i.e.
group of providers and patients at a facility) identified,
tested, and implemented changes to improve chronic
care and preventive processes and patient experience,
by utilizing:
Results
F07
M
-0
7
A
-0
7
M
-0
7
J07
J07
A
-0
7
S
-0
7
O
-0
7
N
-0
7
D
-0
7
J08
F08
M
-0
8
A
-0
8
M
-0
8
J08
J08
A
-0
8
S
-0
8
O
-0
8
N
-0
8
D
-0
8
J09
• The Innovations in Planned Care
(IPC) collaborative focuses on
strengthening the relationship
between the prepared, proactive
care team and the patient, family,
and community.
• Fourteen pilot Indian health facilities responded to a
request for participation and were enrolled in the IPC
collaborative based on the Breakthrough Series
Collaborative model.
Limitations
Weighted Average Diabetes Comprehensive: IPC
60
50
40
30
20
10
• Using change concepts
derived from the Chronic
Care Model, collaborative
teams improved clinical
prevention, management of
chronic conditions, patient
and experience of care.
0
F07
M
-0
7
A
-0
7
M
-0
7
J07
J07
A
-0
7
S
-0
7
O
-0
7
N
-0
7
D
-0
7
J08
F08
M
-0
8
A
-0
8
M
-0
8
J08
J08
A
-0
8
S
-0
8
O
-0
8
N
-0
8
D
-0
8
J09
• In 2006 the IHS launched the
Chronic Care Initiative (CCI)
with the aim of improvement in
clinical prevention and the
management of chronic
conditions using the framework
of the Chronic Care Model.
Methods
Percent Intake Bund
• Chronic and preventable
conditions result in a high burden
of illness in American Indian and
Alaska Native peoples.
for Healthcare Improvement, Cambridge, MA, 2 Indian Health Service, Rockville, MD
Percent DM Comp
Background
1Institute
Intake Screening Bundle
ALL Microsystem
mean improvement
39.3% to 53.7%
# sites
improving
13 (93%)
# site improving
≥ 25%
6 (43%)
Cancer Screening Bundle
50.5% to 57.3%
12 (86%)
3 (21%)
Diabetes Comprehensive
23.4% to 38.7%
11 (79%)
9 (65%)
Measure
• Follow-up is planned to
identify the optimal set and
sequence of changes to
ensure sustainability and
spread of these
improvements.