A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices
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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.
- Crossing the quality chasm: a new health system for the twenty-first century. The National Academy Press, Washington
- Holman, H (2004) Chronic disease—The need for a new clinical education. JAMA 292: pp. 1057-1059 CrossRef
- Stevens, DP, Wagner, EH (2006) Transform residency training in chronic illness care—now. Acad Med 81: pp. 1-3 CrossRef
- Stevens, DP, Sixta, CS, Wagner, EH, Bowen, JL (2008) The evidence is at hand for improving care in settings where residents train. J Gen Intern Med 23: pp. 1116-1117 CrossRef
- Wagner, EH, Austin, BT, Korff, M (1996) Organizing care for chronic disease. Millbank Quarterly 74: pp. 511-544 CrossRef
- McCulloch, DK, Price, MJ, Hindmarsh, MA, Wagner, EH (2000) Improvement in diabetes care using an integrated population-based approach in a primary care setting. Dis Manage 3: pp. 75-82 CrossRef
- Wagner, EH, Austin, BT, Davis, C, Hindmarsh, M, Schaefer, J, Bonomi, A (2001) Improving chronic illness care: translating evidence into action. Health Aff 20: pp. 64-78 CrossRef
- Coleman, K, Austin, BT, Brach, C, Wagner, WH (2009) Evidence on the chronic care model in the new millennium. Health Aff 28: pp. 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, Korff, M (2002) Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res 37: pp. 791-820 CrossRef
- Wagner, EH, Glasgow, RE, David, C, Bonomi, AE, Provost, L, McCulloch, D, Carver, P, Sixta, C (2001) Quality improvement in chronic illness care: A collaborative approach. J Qual Improvement 27: pp. 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 (2003) Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care 12: pp. 458-464 CrossRef
- Daumschroder, LJ, Banaszak-Holl, J, Kowalski, CP, Forman, J, Saint, S, Krein, SL (2009) The role of the “champion” in infection prevention: results from a multisite qualitative study. Qual Saf Health Care 18: pp. 434-440 CrossRef
- Warm, E, Schauer, DP, Diers, T, Mathis, BR, Neirouz, Y, Boex, J, Rouan, GW (2008) The ambulatory long-block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP). J Gen Intern Med 23: pp. 921-926 CrossRef
- Batalden, P, Leach, D, Swing, S, Dreyfus, H, Dreyfus, S (2002) General competencies and accreditation in graduate medical education. Health Aff 21: pp. 103-111 CrossRef
- Davidoff, F (2009) Heterogeneity is not always noise: Lessons from improvement. JAMA 302: pp. 2580-2586 CrossRef
- Grant, RW, Buse, JB, Meigs, JB (2005) Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diab Care 28: pp. 337-442 CrossRef
- Nembhard, IM, Alexander, JA, Hoff, TJ, Ramanujam, R (2009) Why does the quality of health care continue to lag? Insights from management research. Academy of Management Perspectives 23: pp. 24-42
- Feifer, C, Mora, A, White, B, Barnett, BP (2006) Challenges to improving chronic disease care and training in residencies. Acad Med 81: pp. 696-701 CrossRef
- Landon, BE, Hicks, LS, O’Malley, AJ, Lieu, TA, Keegan, T, McNeil, BJ, Guadagnoli, E (2007) Improving the management of chronic disease at community health canters. N Engl J Med 356: pp. 921-934 CrossRef
- Renders, CM, Valk, GD, Franse, LV, Schellevis, FG (2001) 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 24: pp. 1365-1370 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 (2005) Evaluating the efficiency of California providers in caring for patients with chronic illness. Health Aff 24: pp. 526-4
- Davidoff, F, Batalden, P, Stevens, D, Ogrinc, G, Mooney, S (2008) Publication guidelines for quality improvement in health care: evolution of the SQUIRE project. Qual Saf Health Care 17: pp. i3-i9 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