Date: 25 Aug 2010
Implementation of a Chronic Illness Model for Diabetes Care in a Family Medicine Residency Program
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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.
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.
University-affiliated, community-based family medicine residency program.
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.
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.
Through a learning collaborative experience, residency programs can successfully incorporate chronic care training for residents while addressing gaps in care for patients with diabetes.
Improving Chronic Illness Care. The Chronic Care Model. Available at www.improvingchroniccare.org. Accessed October 4, 2009.
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.
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.PubMed
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.CrossRef
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.CrossRef
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.PubMed
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.CrossRef
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
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.
Berwick DM. Developing and testing changes in delivery of care. Ann Int Med. 1998;128:651–6.PubMed
Staker LV. Practice-based learning for improvement: the pursuit of clinical excellence. Tex Med. 2000;96:53–60.PubMed
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.CrossRef
Improving Chronic Illness Care. Practice change: working with academic medical centers. Available at www.improvingchroniccare.org. Accessed October 4, 2009.
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.
- Implementation of a Chronic Illness Model for Diabetes Care in a Family Medicine Residency Program
Journal of General Internal Medicine
Volume 25, Issue 4 Supplement, pp 615-619
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