A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care.
To improve training for residents who provide chronic illness care in teaching practice settings.
US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives—either a national Collaborative, or a subsequent California Collaborative—to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures—HbA1c <7%, LDL <100 mg/dL, and blood pressure ≤130/80—and three process measures—retinal and foot examinations, and patient self-management goals—were tracked.
Fifty-seven teams from 37 self-selected teaching hospitals committed to implement the CCM in resident continuity practices; 41 teams focusing on diabetes improvement participated over the entire duration of one of the Collaboratives.
Teaching-practice teams—faculty, residents and staff—participated in Collaboratives by attending monthly calls and regular 2-day face-to-face meetings with the other teams. The national Collaborative faculty led calls and meetings. Each team used rapid cycle quality improvement (PDSA cycles) to implement the CCM and curricular changes. Teams reported education and clinical performance measures monthly.
Practices underwent extensive redesign to establish CCM elements. Education measures tracked substantial development of CCM-related learning. The clinical and process measures improved, however inconsistently, during the Collaboratives.
These initiatives suggest that systematic practice redesign for implementing the CCM along with linked educational approaches are achievable in resident continuity practices. Improvement of clinical outcomes in such practices is daunting but achievable.
- Institute of Medicine. Crossing the quality chasm: a new health system for the twenty-first century. Washington: The National Academy Press; 2001.
- Holman H. Chronic disease—The need for a new clinical education. JAMA. 2004;292:1057–9. CrossRef
- Stevens DP, Wagner EH. Transform residency training in chronic illness care—now. Acad Med. 2006;81:1–3. CrossRef
- Stevens DP, Sixta CS, Wagner EH, Bowen JL. The evidence is at hand for improving care in settings where residents train. J Gen Intern Med. 2008;23:1116–7. CrossRef
- Wagner EH, Austin BT, Von Korff M. Organizing care for chronic disease. Millbank Quarterly. 1996;74:511–44. CrossRef
- McCulloch DK, Price MJ, Hindmarsh MA, Wagner EH. Improvement in diabetes care using an integrated population-based approach in a primary care setting. Dis Manage. 2000;3:75–82. CrossRef
- Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20:64–78. CrossRef
- Coleman K, Austin BT, Brach C, Wagner WH. Evidence on the chronic care model in the new millennium. Health Aff. 2009;28:75–85. CrossRef
- Institute for Healthcare Improvement. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. 2003.
- Bonomi AE, Wagner EH, Glasgow RE, Von Korff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002;37:791–820. CrossRef
- Wagner EH, Glasgow RE, David C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C. Quality improvement in chronic illness care: A collaborative approach. J Qual Improvement. 2001;27:63–80.
- http://www.ahrq.gov//populations/chroniccaremodel. Accessed April 7, 2010
- Bowen JL, Stevens DP, Provost L, Sixta CS, Johnson JK, Woods DM, Wagner EH. Assessing chronic illness care education (ACIC-E): A tool for tracking educational redesign for improving chronic care education. J Gen Intern Med 2010;XX:XX-XX
- Bowen JL, Stevens DP, Sixta CS, Provost L, Johnson JK, Woods DM, Wagner EH. Developing measures of educational change for collaborative teams implementing the Chronic Care Model in teaching practices. J Gen Intern Med 2010; XX:XX-XX
- Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003;12:458–64. CrossRef
- Daumschroder LJ, Banaszak-Holl J, Kowalski CP, Forman J, Saint S, Krein SL. The role of the “champion” in infection prevention: results from a multisite qualitative study. Qual Saf Health Care. 2009;18:434–40. CrossRef
- Warm E, Schauer DP, Diers T, Mathis BR, Neirouz Y, Boex J, Rouan GW. The ambulatory long-block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP). J Gen Intern Med. 2008;23:921–6. CrossRef
- Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S. General competencies and accreditation in graduate medical education. Health Aff. 2002;21:103–11. CrossRef
- Davidoff F. Heterogeneity is not always noise: Lessons from improvement. JAMA. 2009;302:2580–6. CrossRef
- Grant RW, Buse JB, Meigs JB, University HealthSystem Consortium (UHC) Diabetes Benchmarking Project Team. Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diab Care. 2005;28(2):337–442. CrossRef
- Nembhard IM, Alexander JA, Hoff TJ, Ramanujam R. Why does the quality of health care continue to lag? Insights from management research. Academy of Management Perspectives. 2009;23(2):24–42.
- Feifer C, Mora A, White B, Barnett BP. Challenges to improving chronic disease care and training in residencies. Acad Med. 2006;81:696–701. CrossRef
- Landon BE, Hicks LS, O’Malley AJ, Lieu TA, Keegan T, McNeil BJ, Guadagnoli E. Improving the management of chronic disease at community health canters. N Engl J Med. 2007;356:921–34. CrossRef
- Renders CM, Valk GD, Franse LV, Schellevis FG, vanEijk JT, van der Wal G. Long-term effectiveness of a quality improvement program for patients with Type 2 diabetes in general practice. Diab Care. 2001;24(8):1365–70. CrossRef
- Dearinger AT, Wilson JF, Griffith CH, Scutchfield FD. The effect of resident continuity on diabetes outcomes in a resident community clinic. J Gen Int Med. 2008.
- Wennberg JE, Fisher ES, Baker L, Sharp S, Bronner K. Evaluating the efficiency of California providers in caring for patients with chronic illness. Health Aff. 2005;24(Suppl 3):526–4.
- Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S, SQUIRE development group. Publication guidelines for quality improvement in health care: evolution of the SQUIRE project. Qual Saf Health Care. 2008;17:i3–9. CrossRef
- A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices
Journal of General Internal Medicine
Volume 25, Issue 4 Supplement, pp 574-580
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- residency training
- chronic illness
- teaching hospitals
- Chronic Care Model
- Industry Sectors
- Author Affiliations
- 1. Center for Leadership and Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette Street, Lebanon, NH, 03766, USA
- 2. Oregon Health and Science University, Portland, OR, USA
- 3. Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- 4. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- 5. Associates for Process Improvement, Austin, TX, USA
- 6. Stanford University School of Medicine, Stanford, CA, USA
- 7. UTHSC School of Nursing, Houston, TX, USA
- 8. MacColl Institute for Healthcare Innovation, Group Health Research Institute, Seattle, WA, USA