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Statewide implementation of the chronic care Model for Diabetes: a model for improving care across a diverse region
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CANADIAN JOURNAL OF DIABETES
O-0101 assessing the impact of conducting an essential public health services assessment in diabetes prevention and control programs M. Saunders1 Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, USA
1
aims: To discuss the Essential Public Health Services assessment, the importance of completing DPCPs and how this can lead to quality improvements in diabetes care. background: The goal of the Essential Public Health Services (EPHS) assessment is to promote continuous quality improvements. In 2002, the Division of Diabetes Translation (DDT) recommended that state Diabetes Prevention and Control Programs (DPCPs) complete an EPHS assessment and use the findings of this assessment to develop a state Performance Improvement Plan/s (PIP) and a Diabetes Strategic Plan. Methods: DPCP data submitted to the DDT’s Management Information System (MIS) were reviewed using several evaluation criteria, including the completion of an EPHS assessment; completion of one or more PIPs; completion of a diabetes strategic plan addressing quality improvement issues identified during the assessment; and a review of how current DPCP efforts, as described in their work plans, aligned with the findings of the assessment. results: MIS searches revealed that, in 2008, 58 of 59 DPCPs (98%) completed an EPHS assessment. Three DPCPs used the original EPHS assessment; fifty six (56) DPCPs used a modified version. By 2005, 39 of 59 of DPCPs (66%) completed a PIP, and by 2008, 90% of programs had completed at least one PIP. Additionally, two programs completed more than one PIP during the five year funding period. An analysis of the top three priorities identified by all DPCPs during the assessment revealed several quality improvement themes, such as: health systems improvement, partnerships, surveillance, prevention and wellness, advocacy and policy, professional education and training, disparities, evaluation, and communication. Other priorities included community programs, research promotion, assessment and planning, integration, systems approach to diabetes, social marketing and health care reform. In 2005, 61% of all funded programs had a diabetes strategic plan in place and that number rose to 85% in 2008. In 2008, analysis of MIS reports and a review of current work plan templates indicated that more than 85% of the work of the DPCPs showed direct alignment to the EPHS assessment findings. Discussion/conclusions Conducting EPHS assessments and using the data for continued quality improvement activities can have significant impact on DPCPs. This assessment allowed states to identify priority areas and assisted in the development of work plans to address quality improvement concerns. The alignment of the DPCP work plans to the findings of their EPHS is critical in ensuring that DPCPs work to address gaps, and work to strengthen the diabetes public health system. DDT will need to continue to work with DPCPs to ensure that work plans are aligned with the EPHS assessment findings, so that critical gains can be maintained across the diabetes pubic health system. National and local plans and initiatives No conflict of interest O-0102 statewide implementation of the chronic care Model for Diabetes: a model for improving care across a diverse region R. Gabbay1, L. Siminerio2 1 Penn State College of Medicine, Penn State Institute for Diabetes and Obesity, Hershey, USA 2 University of Pittsburgh, Department of Medicine, Pittsburgh, USA aim: The primary care system, where most of diabetes care is provided, is insufficiently oriented toward the management and maintenance of those with chronic illnesses such as diabetes. The Chronic Care
Model (CCM) provides the best evidence-based framework to transform this care from an acute and reactive system to a proactive, planned and population-based system of care. To date, however, most implementations of the CCM have been in larger practice organizations due in part to unsupported reimbursement for chronic care elements and a mismatch between those who bear the implementation costs and those who potentially receive the financial benefit within the US health care system. The goal of this three year intervention was to align financial resources, health care providers, and patients to implement the CCM across Pennsylvania (PA), a large diverse US state (117,000 sq km) with a population of 12 million, including 800,000 with diabetes. Methods: In 2007, multi-stakeholders from across the State developed a blueprint for how efforts, resources and interests could be combined to strengthen the collective capacity to improve diabetes care. This initiative coincided with the PA Governor’s establishment of the Chronic Care Commission, charged with implementing the CCM across the State with a focus on diabetes. Implementation of the CCM is being driven by significant practice incentives supported by insurers aligned with the Patient Centered Medical Home. Regional Learning Collaboratives are supported by a free (state-supported) diabetes registry, monthly data reporting requirements, regular meetings and trained practice coaches working individually with primary care practices. results: Learning Collaboratives have occurred across different regions of the state; each engaging approximately 25 practices of various sizes with diabetes populations of roughly 5000 per collaborative. The first of these collaboratives (Philadelphia region) has completed one year of the intervention with monthly reporting of outcomes. Considerable practice changes have been implemented in Clinical Information Systems, Delivery System Design and Decision Support and have recognized the central role of Self-Management Support and Community partnerships to improve care. Several clinical measures and process measures have already improved. conclusion: This unique undertaking, in one of the US’s largest states, merging for the first time changes in reimbursement with incentives for CCM implementation, holds significant promise to transform health care in other regions and establishes a potential national model for systematic chronic disease management. National and local plans and initiatives No conflict of interest O-0103 staged diabetes management IssstE: the First National Diabetes Program in Mexico J. Rodriguez-Saldana1, M.A. Morales de Teresa1, C. Tena-Tamayo2, M. Blanco-Cornejo2, I.L. Rivapalacio y Chiang Sam2, I. Sanchez-Diaz2, L.I. Vazquez-Rodriguez1, C.B. Rangel-Leon1 1 Resultados Medicos Desarrollo e Investigacion SC, General Direction, Pachuca de Soto, Mexico 2 ISSSTE, Sudirección General Medica, Mexico City, Mexico Introduction: Diabetes has become the first cause of mortality in Mexico. Leading contributing factors include lack of coverage/access to care, deficiencies in training of general practitioners and specialists, persistence of the acute model for chronic disease care, a vertical prescriptive approach, and abscence or denial of diabetes self care education by practitioners, institutions and medical societies. objectives: 1) Achieve a 20 percent reduction in mortality due to diabetes by 2011; 2) develop a high quality model of outpatient diabetes care; 3) increase national coverage/access to diabetes care; 4) reduce the rate of acute complications; 5) reduce the rate and the progression of chronic complications; 6) reduce direct costs of diabetes; 7) improve the quality of life of persons with diabetes; 8) introduce self-care diabetes education as an essential component of the Diabetes Program at ISSSTE. Starting in 2007, implementation of Staged Diabetes Management, a structured program developed by the International Diabetes Center, a WHO Collaborative Center from Minneapolis MN,
CANADIAN JOURNAL OF DIABETES
O-0101 assessing the impact of conducting an essential public health services assessment in diabetes prevention and control programs M. Saunders1 Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, USA
1
aims: To discuss the Essential Public Health Services assessment, the importance of completing DPCPs and how this can lead to quality improvements in diabetes care. background: The goal of the Essential Public Health Services (EPHS) assessment is to promote continuous quality improvements. In 2002, the Division of Diabetes Translation (DDT) recommended that state Diabetes Prevention and Control Programs (DPCPs) complete an EPHS assessment and use the findings of this assessment to develop a state Performance Improvement Plan/s (PIP) and a Diabetes Strategic Plan. Methods: DPCP data submitted to the DDT’s Management Information System (MIS) were reviewed using several evaluation criteria, including the completion of an EPHS assessment; completion of one or more PIPs; completion of a diabetes strategic plan addressing quality improvement issues identified during the assessment; and a review of how current DPCP efforts, as described in their work plans, aligned with the findings of the assessment. results: MIS searches revealed that, in 2008, 58 of 59 DPCPs (98%) completed an EPHS assessment. Three DPCPs used the original EPHS assessment; fifty six (56) DPCPs used a modified version. By 2005, 39 of 59 of DPCPs (66%) completed a PIP, and by 2008, 90% of programs had completed at least one PIP. Additionally, two programs completed more than one PIP during the five year funding period. An analysis of the top three priorities identified by all DPCPs during the assessment revealed several quality improvement themes, such as: health systems improvement, partnerships, surveillance, prevention and wellness, advocacy and policy, professional education and training, disparities, evaluation, and communication. Other priorities included community programs, research promotion, assessment and planning, integration, systems approach to diabetes, social marketing and health care reform. In 2005, 61% of all funded programs had a diabetes strategic plan in place and that number rose to 85% in 2008. In 2008, analysis of MIS reports and a review of current work plan templates indicated that more than 85% of the work of the DPCPs showed direct alignment to the EPHS assessment findings. Discussion/conclusions Conducting EPHS assessments and using the data for continued quality improvement activities can have significant impact on DPCPs. This assessment allowed states to identify priority areas and assisted in the development of work plans to address quality improvement concerns. The alignment of the DPCP work plans to the findings of their EPHS is critical in ensuring that DPCPs work to address gaps, and work to strengthen the diabetes public health system. DDT will need to continue to work with DPCPs to ensure that work plans are aligned with the EPHS assessment findings, so that critical gains can be maintained across the diabetes pubic health system. National and local plans and initiatives No conflict of interest O-0102 statewide implementation of the chronic care Model for Diabetes: a model for improving care across a diverse region R. Gabbay1, L. Siminerio2 1 Penn State College of Medicine, Penn State Institute for Diabetes and Obesity, Hershey, USA 2 University of Pittsburgh, Department of Medicine, Pittsburgh, USA aim: The primary care system, where most of diabetes care is provided, is insufficiently oriented toward the management and maintenance of those with chronic illnesses such as diabetes. The Chronic Care
Model (CCM) provides the best evidence-based framework to transform this care from an acute and reactive system to a proactive, planned and population-based system of care. To date, however, most implementations of the CCM have been in larger practice organizations due in part to unsupported reimbursement for chronic care elements and a mismatch between those who bear the implementation costs and those who potentially receive the financial benefit within the US health care system. The goal of this three year intervention was to align financial resources, health care providers, and patients to implement the CCM across Pennsylvania (PA), a large diverse US state (117,000 sq km) with a population of 12 million, including 800,000 with diabetes. Methods: In 2007, multi-stakeholders from across the State developed a blueprint for how efforts, resources and interests could be combined to strengthen the collective capacity to improve diabetes care. This initiative coincided with the PA Governor’s establishment of the Chronic Care Commission, charged with implementing the CCM across the State with a focus on diabetes. Implementation of the CCM is being driven by significant practice incentives supported by insurers aligned with the Patient Centered Medical Home. Regional Learning Collaboratives are supported by a free (state-supported) diabetes registry, monthly data reporting requirements, regular meetings and trained practice coaches working individually with primary care practices. results: Learning Collaboratives have occurred across different regions of the state; each engaging approximately 25 practices of various sizes with diabetes populations of roughly 5000 per collaborative. The first of these collaboratives (Philadelphia region) has completed one year of the intervention with monthly reporting of outcomes. Considerable practice changes have been implemented in Clinical Information Systems, Delivery System Design and Decision Support and have recognized the central role of Self-Management Support and Community partnerships to improve care. Several clinical measures and process measures have already improved. conclusion: This unique undertaking, in one of the US’s largest states, merging for the first time changes in reimbursement with incentives for CCM implementation, holds significant promise to transform health care in other regions and establishes a potential national model for systematic chronic disease management. National and local plans and initiatives No conflict of interest O-0103 staged diabetes management IssstE: the First National Diabetes Program in Mexico J. Rodriguez-Saldana1, M.A. Morales de Teresa1, C. Tena-Tamayo2, M. Blanco-Cornejo2, I.L. Rivapalacio y Chiang Sam2, I. Sanchez-Diaz2, L.I. Vazquez-Rodriguez1, C.B. Rangel-Leon1 1 Resultados Medicos Desarrollo e Investigacion SC, General Direction, Pachuca de Soto, Mexico 2 ISSSTE, Sudirección General Medica, Mexico City, Mexico Introduction: Diabetes has become the first cause of mortality in Mexico. Leading contributing factors include lack of coverage/access to care, deficiencies in training of general practitioners and specialists, persistence of the acute model for chronic disease care, a vertical prescriptive approach, and abscence or denial of diabetes self care education by practitioners, institutions and medical societies. objectives: 1) Achieve a 20 percent reduction in mortality due to diabetes by 2011; 2) develop a high quality model of outpatient diabetes care; 3) increase national coverage/access to diabetes care; 4) reduce the rate of acute complications; 5) reduce the rate and the progression of chronic complications; 6) reduce direct costs of diabetes; 7) improve the quality of life of persons with diabetes; 8) introduce self-care diabetes education as an essential component of the Diabetes Program at ISSSTE. Starting in 2007, implementation of Staged Diabetes Management, a structured program developed by the International Diabetes Center, a WHO Collaborative Center from Minneapolis MN,