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Implementation of a Chronic Illness Model for Diabetes Care in a Family Medicine Residency Program

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ABSTRACT

INTRODUCTION

While the Chronic Care Model (CCM) has been shown to improve the care of patients with chronic illnesses, primary care physicians have been unprepared in its use, and residencies have encountered challenges in introducing it into the academic environment.

AIM

Our residency program has implemented a diabetes management program modeled on the CCM to evaluate its impact on health outcomes of diabetic patients and educational outcomes of residents.

SETTING

University-affiliated, community-based family medicine residency program.

PROGRAM DESCRIPTION

Six residents, two faculty clinicians, and clinic staff formed a diabetes management team. We redesigned the outpatient experience for diabetic patients by incorporating elements of the CCM: multidisciplinary team care through planned and group visits; creation of a diabetes registry; use of guidelines-based flow sheets; and incorporation of self-management goal-setting. Residents received extensive instruction in diabetes management, quality improvement, and patient self-management.

PROGRAM EVALUATION

We achieved overall improvement in all metabolic and process measures for patients, with the percentage achieving HbA1c, LDL, and BP goals simultaneously increasing from 5.7% to 17.1%. Educational outcomes for residents, as measured by compliance with review of provider performance reports and self-management goal-setting with patients, also significantly improved.

DISCUSSION

Through a learning collaborative experience, residency programs can successfully incorporate chronic care training for residents while addressing gaps in care for patients with diabetes.

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References

  1. Improving Chronic Illness Care. The Chronic Care Model. Available at www.improvingchroniccare.org. Accessed October 4, 2009.

  2. Holman H. Chronic disease – the need for a new clinical education. JAMA. 2004;292:1057–9.

    Article  CAS  PubMed  Google Scholar 

  3. Hoffman C, Rice D, Sung HY. Persons with chronic conditions: their prevalence and costs. JAMA. 1996;276:1473–9.

    Article  CAS  PubMed  Google Scholar 

  4. DeVol R, Bedroussian A. An unhealthy America: the economic burden of chronic disease – charting a new course to save lives and increase productivity and economic growth. Milken Institute. October 2007.

  5. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775–9.

    Article  PubMed  Google Scholar 

  6. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA. 2002;288(15):1909–14.

    Article  PubMed  Google Scholar 

  7. Wagner EH, Glasgow RE, Davis C, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27(2):63–80.

    CAS  PubMed  Google Scholar 

  8. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20(6):64–78.

    Article  CAS  Google Scholar 

  9. Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the chronic care model in the new millennium. Health Aff (Millwood). 2009;28(1):75–85.

    Article  Google Scholar 

  10. McCulloch DK, Price MJ, Hindmarsh M, Wagner EH. A population-based approach to diabetes management in a primary care setting: early results and lessons learned. Eff Clin Pract. 1998;1(1):12–22.

    CAS  PubMed  Google Scholar 

  11. Chin MH, Cook S, Drum ML, et al. Improving diabetes care in Midwest community health centers with the health disparities collaborative. Diab Care. 2004;27:2–8.

    Article  Google Scholar 

  12. Wang A, Wolf M, Carlyle R, Wilkerson J, Porterfield D, Reaves J. The North Carolina experience with the diabetes health disparities collaboratives. Jt Comm J Qual Saf. 2004;30(7):396–404.

    PubMed  Google Scholar 

  13. Darer JD, Hwang W, Pham HH, Bass EB, Anderson G. More training needed in chronic care: a survey of US physicians. Acad Med. 2004;79:541–8.

    Article  PubMed  Google Scholar 

  14. Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey Bass; 2009.

    Google Scholar 

  15. Berwick DM. Developing and testing changes in delivery of care. Ann Int Med. 1998;128:651–6.

    CAS  PubMed  Google Scholar 

  16. Staker LV. Practice-based learning for improvement: the pursuit of clinical excellence. Tex Med. 2000;96:53–60.

    CAS  PubMed  Google Scholar 

  17. Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002;37(3):791–820.

    Article  PubMed  Google Scholar 

  18. Solberg LI, Crain AL, Sperl-Hillen JM, Hroscikoski MC, Engebretson KI, O’Connor PJ. Care quality and implementation of the chronic care model: a quantitative study. Ann Fam Med. 2006;4(4):310–6.

    Article  PubMed  Google Scholar 

  19. Si D, Bailie R, Connors C, et al. Assessing health centre systems for guiding improvement in diabetes care. BMC Health Serv Res. 2005;5:56.

    Article  PubMed  Google Scholar 

  20. Resnick HE, Foster GL, Bardsley J, Ratner RE. Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999–2002: the national health and nutrition examination survey. Diab Care. 2006;29(3):531–7.

    Article  Google Scholar 

  21. Improving Chronic Illness Care. Practice change: working with academic medical centers. Available at www.improvingchroniccare.org. Accessed October 4, 2009.

  22. Feifer C, Mora A, White B, Barnett BP. Challenges to improving chronic illness care and training in residencies. Acad Med. 2006;81(8):696–701.

    Article  PubMed  Google Scholar 

  23. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45.

    Article  PubMed  Google Scholar 

  24. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health objectives for improving health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.

  25. O’Connor PJ. Commentary – improving diabetes care by combating clinical inertia. Health Serv Res. 2005;40(6):1854–61.

    Article  PubMed  Google Scholar 

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Acknowledgements

This program was funded by Improving Chronic Illness Care and the California Health Care Foundation, in collaboration with the Association of American Medical Colleges. The authors would like to acknowledge the hard work of all of the participants of the OFHC Diabetes Management Team, with special thanks to the following individuals: David McKay, MD, MPH; Robert Norman, MD; Nancy Morioka-Douglas, MD, MPH; Leticia Martinez, RN; Jena Eidschun; David Hiroshima, MD; Tam Nguyen, MD; Rowan Paul, MD; Christie Shen, MD; and Katherine Vega, MD. The authors also thank the faculty of the CA-ACCC, Ed Wagner, MD, MPH; David Stevens, MD; Judith Bowen, MD; and Connie Sixta, RN, PhD, MBA, for their guidance and support, and the representatives of the other participating institutions for their sharing and dissemination of ideas and best practices.

Conflict of Interest

None disclosed.

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Correspondence to Grace Chen Yu MD.

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Yu, G.C., Beresford, R. Implementation of a Chronic Illness Model for Diabetes Care in a Family Medicine Residency Program. J GEN INTERN MED 25 (Suppl 4), 615–619 (2010). https://doi.org/10.1007/s11606-010-1431-9

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  • DOI: https://doi.org/10.1007/s11606-010-1431-9

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