IMPROVING QUALITY OF CARE USING THE CHRONIC CARE MODEL HEALTH FOUNDATION OF SOUTH FLORIDA, PRIMARY CARE COMMUNITY DIALOGUE, November 15, 2007 St. Anthony.

IMPROVING QUALITY OF CARE USING THE CHRONIC CARE MODEL

HEALTH FOUNDATION OF SOUTH FLORIDA,PRIMARY CARE COMMUNITY DIALOGUE, November 15, 2007

St. Anthony Amofah, MD MBAMedical Director, Health Choice Network,

Chief Medical Officer, Community Health of South Florida, Inc.

COMMUNITIES THAT CARECOMMUNITIES THAT CARE

CHRONIC DISEASES; The health care dilemma

Burden of chronic diseases in US Significant mortality from DM,

Stroke, Heart Disease Yet current data on care indicators

are still alarming Positive outcomes achievable Multiple approaches implemented

over the years Marginal improvements

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THE CHRONIC CARE MODEL AS A SUCCESSFUL APPROACH TO

IMPROVING CHRONIC DISEASE CARE

1. A Comprehensive approach

2. Meets criteria for a stellar approach to care management:

a. Evidence-basedb. Patient-centeredc. Population-focused

3. Making a sustainable, demonstrable difference

4. Transforming U.S. Healthcare

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CHCs POSITIONED TO DRAMATICALLY IMPROVE

HEALTHCARE With federally funded health centers having fully embraced the (Chronic Disease Care) model.. This has become arguably the largest, most important health care quality improvement initiative in the country. It’s exactly what the health care system needs right now – a demonstration that it is possible both to improve care dramatically and even reduce health care costs.” Tracy Orleans, PH.D., Senior Scientist,

Advances Online, RWJ Foundation Newsletter

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BPHC Policy Information Notice 2002-12 EXPECTATIONS

The Collaborative care and improvement models are key elements in the multi-year BPHC strategy to improve health outcomes for underserved people. Consequently, the BPHC expects all health centers to participate in the health disparities collaborative program. This expectation includes successful completion of a year-long BPHC-supported or sponsored health disparities collaborative learning experience, or Phase 1, and the continued spread of the model, documenting and sharing core measures through monthly reports after the first year (Phase 2). In addition, eligibility or preference for many future funding opportunities focused on expansion of health center services, will require successful and continual participation in both phase 1 and 2 of the health disparities collaborative initiative. This includes continued submission of the senior leader report. Since participation in the Health Disparities Collaborative should be part of an organization wide-commitment, alignment of goals, and strategy and policies for quality improvement, the health center governing board must be actively involved as described in the Program Expectations. Those health centers actively engaged in the health disparities collaborative are exempt from reporting audit data and goals from the 1991 Clinical Outcomes Measures in their grant application. However, these health centers are encouraged to use these measures and goals internally for performance improvement. In addition, many of these Clinical Outcomes Measures and goals will be incorporated in future collaboratives, such as prevention, cancer, and infant mortality. Health centers in collaboratives are documenting outstanding results in diabetes, asthma, depression and cardiovascular care. Public and private partnerships at the national, State and local level have facilitated these outstanding results. Health centers will find that successful participation in the collaboratives helps in accreditation, including the new accreditation programs for chronic disease management, the Primary Care Effectiveness Review, and presenting an effective continuing or competitive grant application to BPHC. Outstanding health center results also aid health centers to compete for local and State opportunities. Moreover, these outcomes are recognized locally, nationally, and internationally. In the future, there will be new opportunities to work in other clinical areas, such as cancer and prevention, as well as diabetes mellitus, cardiovascular disease, asthmas and depression. For additional, updated information, and applications to participate, please refer to www.healthdisparities.net. BPHC Policy Information Notice 2002-12

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GOAL OF PRESENTATION

TO DISCUSS HOW THE IMPLEMENTATION OF THE CHRONIC CARE MODEL CAN AND WILL HELP TO IMPROVE CHRONIC DISEASE CARE

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OUTLINE What is the Chronic Care Model? What are the key components of

the Model? What makes this Model unique? Challenges implementing the

Chronic Care Model How can a health care organization

implement this Model?

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WHAT IS THE CHRONIC CARE MODEL?

One of 3 Models used to improve chronic disease outcomes

Developed at MacColl Institute for Healthcare Innovation

Adopted and promoted by IHI and HRSA Chronic Care Model

To improve Functional and Clinical Outcomes

Productive interactions between an Informed, Activated Patient and a Prepared, Proactive Team

Application of all 6 components of the Care Model

COMMUNITIES THAT CARECOMMUNITIES THAT CARE

CHRONIC CARE MODEL

Health System

Health Care Organization

Self-management

support

Delivery System Design

Decision Support

Clinical Information

Systems

Community

Resources and Policies

Functional and Clinical Outcomes

Informed Activated Patient

Prepared, Proactive

Practice Team

COMMUNITIES THAT CARECOMMUNITIES THAT CARE

CLINICAL INFORMATION SYSTEMS

A component of the Care Model Applicability to Chronic Disease Care

Patient Registries for Tracking Care planning

Provider/Staff reminder systems/care prompts

Trends in selected indices Individual Population

Data aggregation for feedback, benchmarking and grant writing

COMMUNITIES THAT CARECOMMUNITIES THAT CARE

DECISION SUPPORT

A component of the Care Model Tools that help to support decision-

making by Providers and Patients. Decisions to be made at a HTN patient’s

visit: Which type of BP medication should be used for this

particular patient? Which lab tests is this patient due for? Do I need to treat this patient with this cholesterol

level? Does this patient need to be referred to the Kidney

Specialist?

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DECISION SUPPORT

WHAT TOOLS HELP PROVIDERS IN DECISION-MAKING FOR HTN PATIENTS?

Published Hypertension management guidelines Textbooks, Journals, Knowledge/Web links on desktops

(emedicine.org, familydoctor.org, uptodate.org) Embedding guidelines in forms, templates, EHR’s

Flow Sheets Quality Care Guidelines system

Easily accessible patient-specific data

WHAT TOOLS HELP HTN PATIENTS IN DECISION-MAKING?

Patient friendly education material Trended patient-specific data

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DELIVERY SYSTEM DESIGN

A component of the Care Model.

Patient care system’s ability to facilitate optimal management of patients

DELIVERY SYSTEM? Patient flow Patient scheduling Medical Record flow Processing of flow sheets Staff assignments

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SELF-MANAGEMENT A component of the Care Model

Patients take charge of managing their diseases by themselves

It involves Educating patients on guidelines on

managing their diseases Helping them to select behavioral change

goals. (E.g. Diet & Exercise goals). Working with them to achieve the goals.

(Addressing barriers, follow-up calls, etc).

COMMUNITIES THAT CARECOMMUNITIES THAT CARE

COMMUNITY

A component of the Care Model. Emphasizes importance of

External resources Partnerships Policies

It involves Linking patients with chronic diseases to

community based programs Providing screenings and education in the

community Helping to establish facilities for exercise

programs, recreation, etc Developing partnerships with organizations

that may provide support in cash or in kind

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HEALTH CARE ORGANIZATION

A component of the Care Model

This refers to Leadership support of chronic disease

care activities Strategies to sustain organization-

wide changes Strategic plan Policies and Procedures Job Descriptions Staff Incentive plan

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THE OTHER 2 MODELS THAT SUPPORT IMPLEMENTATION OF THE

CARE MODEL Improvement model Testing, Fine-tuning, Rolling out,

Feedback, Refining, Adopting, etc PDSA Cycles

Learning model Rapid, radical transformation Learn from others Via Learning Session, Conference Calls,

Listservs

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WHAT MAKES THE CHRONIC CARE MODEL SUCH A UNIQUE APPROACH TO IMPROVING

OUTCOMES1. Comprehensiveness of approach

Model concept

2. Public AND Private sector support

3. Evidence-based

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EVIDENCE BASIS FOR CHRONIC CARE MODEL

Article:  Systematic Review of the Chronic Care Model in Chronic Obstructive Pulmonary Disease Prevention and Management

Pooled data demonstrate that patients with chronic obstructive pulmonary disease who received interventions with two or more CCM components had lower rates of hospitalizations and emergency visits and a shorter length of stay compared with control groups. Read the 

Archives of Internal Medicine article Adams SG, Smith PK, Allan PF, Anzueto A, Pugh JA, Cornell JE. Department of Medicine, The University of Texas Health Science Center

at San Antonio, USA. [email protected]

Article:  Can a Chronic Care Model Collaborative Reduce Heart Disease Risk in Patients With Diabetes?

This study concludes that CCM collaborative intervention lowered the cardiovascular disease risk factors of patients with diabetes who were cared for in the participating organization’s settings.

Read the Journal of General Internal Medicine article Vargas RB, Mangione CM, Asch S, Keesey J, Rosen M, Schonlau M,

Keeler EB. Division of General Internal Medicine and Health Services Research,

David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. [email protected]

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CHALLENGES WITH IMPLEMENTING CHRONIC CARE MODEL

Dual Data Entry Requirement of PECS Appropriate Decision Support Tools and

Systems Staffing for Intensive Self-Management

Support and Delivery System Re-design Expertise necessary for Effective

Change Management $ Support for Labs, Meds, etc Revenue loss from scheduling changes Soliciting community support and

partnerships

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SUMMARY What is the Chronic Care Model? What are the key components of

the Model? What makes this Model unique? Challenges implementing the

Chronic Care Model How can the HFSF support the

implementation of this Model?

COMMUNITIES THAT CARECOMMUNITIES THAT CARE

HOW CAN THE HFSF SUPPORT SPREAD OF CARE MODEL?

Community dialogue Focused educational sessions on

use of Care Model Nidus for public-private

partnerships Grant-funding for:

Infrastructure development Staffing Equipment/Supplies

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HELPFUL REFERENCES Health Disparities Collaboratives

www.healthdisparities.net

Institute for Healthcare Improvement www.ihi.org

Accelerating Change Today Report 2002 http://www.improvingchroniccare.org/downloads/

act_report_may_2002_curing_the_system.pdf

THANK YOU

St Anthony Amofah, MD MBAMedical Director, HCN

Chief Medical Officer, [email protected]

COMMUNITIES THAT CARECOMMUNITIES THAT CARE

“TAKE HOME MESSAGES”

“Current care systems cannot do the job

Trying harder will not work Changing systems of care will”.

The Chronic Care Model presents a sustainable approach to changing the systems of care!