An Asthma and Diabetes Quality Improvement Project: Enhancing Care in Clinics and Community Health Centers
- 349 Downloads
Asthma and diabetes are major chronic conditions in the United States, particularly in the Medicaid population. The majority of care for these diseases occurs at ambulatory practice sites. The New York State Department of Health Office of Health Insurance Programs (OHIP) worked with IPRO, the New York State Medicare quality improvement organization, to develop and implement a quality improvement project (QIP) for these conditions. The approach was based upon the Chronic Care Model and used an iterative academic-detailing methodology. Clinics and community health centers volunteered to participate and used IPRO-collected data with audit and feedback to improve their practices. Several metrics significantly improved for asthma (e.g., use of anti-inflammatory long term controller agents, assessment of asthma severity, use of asthma action plans) and for diabetes (e.g., lipid testing and control, A1c testing). Key organizational elements of success included senior medical leadership commitment and practice site quality improvement team meetings. OHIP has used the QIP experience to begin patient-centered medical home implementation in New York State.
KeywordsAsthma Diabetes Quality improvement Ambulatory care
The authors wish to thank Dr. Foster Gesten, Medical Director, Office of Health Insurance Programs for his review of the manuscript; Ms. Katja Ocepek-Welikson and Mr. Ti-Kuang Lee of IPRO for their assistance in the data analysis.
- 1.The Henry J Kaiser Family Foundation. (2004). Kaiser state health facts, total medicaid spending. Available at: http://www.statehealthfacts.org/comparemaptable.jsp?ind=177&cat=4. Accessed February 16, 2010.
- 2.New York State Office of the Governor. (2008). Governor patterson announces state budget expands health care coverage to every uninsured New York child. April 9, 2008. Available at:, http://www.state.ny.us/governor/press/press_0409088.html. Accessed February 16, 2010.
- 4.Group Health Research Institute. (2009). Improving chronic illness care. Available at http://www.improvingchroniccare.org. Accessed February 16, 2010.
- 7.National Heart, Lung and Blood Institute. (2007). National asthma education and prevention program. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma-full report, August 28, 2007.Google Scholar
- 8.Group Health Research Institute. (2009). The chronic care model. Available at: http://improvingchroniccare.org/index.php?p=Model_Elements&s=18. Accessed February 16, 2010.
- 9.Group Health Research Institute. (2009). The RAND evaluation. Available at: http://www.improvingchroniccare.org/index.php?p=The_RAND_Evaluation&s=32. Accessed February 16, 2010.
- 10.DiClemente, C. C., & Prochaska, J. (1998). Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors (2nd ed.). New York: Plenum.Google Scholar
- 11.Midwest Latino Health Research. (2009). Training and policy center of University of Illinois at Chicago. Diabetes empowerment education program. Available at: http://www.uic.edu/jaddams/mlhrc/Programs/DEEP.htm. Accessed at February 16, 2010.
- 12.Stanford Patient Education Research Center. (2009). Stanford self-management programs. Available at: http://patienteducation.stanford.edu/programs/. Accessed February 16, 2010.
- 13.SAS Institute Inc. (2009). SAS/STAT (r)9.2. User’s Guide, 2nd Edn. Cary, NC: SAS Institute Inc. Chapter 69, the SURVEYLOGISTIC Procedure. Available at: http://support.sas.com/onlinedoc/913/getDoc/en/statug.hlp/surveylogistic_index.htm#stat_surveylogistic Accessed May 3, 2010.
- 14.Weisstein, E. W. (2010) “Bonferroni Correction.” From MathWorld—A wolfram web resource. Available at: http://mathworld.wolfram.com/BonferroniCorrection.html. Accessed February 17, 2010.
- 17.Aronson, N., Lefevre, F., & Piper, M., et al. (2001) Management of chronic asthma. Evidence report/technology assessment number 44-prepared by blue cross and blue shield association technology evaluation center AHRQ Pub. No. 01-Eo44 Rockville, MD, September 2001.Google Scholar
- 18.IPRO. (2009). Asthma in primary care practice CME. Available at: http://www.ipro.org/index/asthma-cme. Accessed February 16, 2010.
- 19.New York State Department of Health. (2009). New York state smokers’ quitline. Available at: http://www.nysmokefree.com/newweb/default.aspx. Accessed February 16, 2010.
- 20.New York State Department of Health. (2009). Asthma action plan and informational materials. Available at: http://www.health.state.ny.us/diseases/asthma/brochures.htm. Accessed February 16, 2010.
- 21.Toelle, B. G., & Ram, F. S. F. (2004) Written individualized management plans for asthma in children and adults. Cochrane Database of Systematic Reviews (1). Art. No.: CD002171. DOI: 10.1002/14651858.CD002171.pub2 Accessed on May, 05, 2008.
- 26.National Committee for Quality Assurance. (2009). Physician Practice Connections® Patient-Centered Medical Home™. Available at: http://www.ncqa.org/tabid/631/Default.aspx. Accessed February 16, 2010.
- 27.New York State Department of Health. (2009). Announcing New York medicaid’s statewide patient-centered medical home incentive program. New York State Medicaid Update December 25(16). Available at: http://www.health.state.ny.us/health_care/medicaid/program/update/2009/2009-12spec.htm. Accessed February 16, 2010.