Quality Improvement in Chronic Illness Care: A Collaborative Approach

Wagner, Edward H.; Glasgow, Russell E.; Davis, Connie L.; Bonomi, Amy E.; Provost, Lloyd; McCulloch, David K.; Carver, Penny; Sixta, Connie S.

doi:10.1016/s1070-3241(01)27007-2

Cited by 535 publications

(531 citation statements)

References 16 publications

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“…Chronic disease care will need to be established as a long-term strategic priority for primary care services, and as such will require ongoing management attention, regular revitalisation and appropriate resourcing of the approach. Attention needs to be paid to all causal mechanisms, including the specific contribution of implementation processes underpinning service pro-grammes if the development of models for chronic illness care (Wagner, Glasgow et al, 2001) are to lead to continuous improvement in routine service delivery, and in turn to sustained health benefits for patients. Pressure on staff and their organisations to perform to a high standard in the expectation that this will lead to improved outcomes for their clients needs to be backed by good evidence on what needs to be sustained-or reinvented-and how it can be done.…”

Section: Resultsmentioning

confidence: 99%

Investigating the sustainability of outcomes in a chronic disease treatment programme

Bailie

Robinson

Kondalsamy‐Chennakesavan

et al. 2006

Social Science & Medicine

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This study examines trends in chronic disease outcomes from initiation of a specialised chronic disease treatment programme through to incorporation of programme activities into routine service delivery. We reviewed clinical records of 98 participants with confirmed renal disease or hypertension in a remote indigenous community health centre in Northern Australia. For each participant the review period spanned an initial three years while participating in a specialised cardiovascular and renal disease treatment programme and a subsequent three years following withdrawal of the treatment programme. Responsibility for care was incorporated into the comprehensive primary care service which had been recently redeveloped to implement best practice care plans. The time series analysis included at least six measures prior to handover of the specialised programme and six following handover. Main outcome measures were trends in blood pressure (BP) control, and systolic and diastolic BP. We found an improvement in BP control in the first 6-12 months of the programme, followed by a steady declining trend. There was no significant difference in this trend between the pre-compared to the post-programme withdrawal period. This finding was consistent for control at levels below 130/80 and 140/90, and for trends in mean systolic and diastolic BP. Investigation of the sustainability of programme outcomes presents major challenges for research design. Sustained success in the management of chronic disease through primary care services requires better understanding of the causal mechanisms related to clinical intervention, the basis upon which they can be 'institutionalised' in a given context, and the extent to which they require regular revitalisation to maintain their effect.

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Section: Resultsmentioning

confidence: 99%

Investigating the sustainability of outcomes in a chronic disease treatment programme

Bailie

Robinson

Kondalsamy‐Chennakesavan

et al. 2006

Social Science & Medicine

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“…MaineHealth utilized the Institute for Healthcare Improvement's (IHI) Learning Collaborative (Wagner et al, 2001) as the framework for organizing sessions at which its flexible blueprint model was introduced to involved practices. Since varied perspectives are often needed to facilitate the process of change, the participating clinical teams typically included a physician-site leader, practice nurse, and operations person.…”

Section: Preparing Practices and Implementation Start-upmentioning

confidence: 99%

Implementation of Guideline-Based Care for Depression in Primary Care

Rollman

Korsen

Schulberg

2005

Adm Policy Ment Health

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Evidence-based clinical practice guidelines for treating depression in primary care settings were developed, in part, to ensure that health services are provided in a consistent, highquality, and cost-effective manner. Yet for a variety of reasons, guideline-based primary care for depression remains the exception rather than the rule. This work provides a brief review of effective strategies used to customize and then deliver evidence-based treatment for depression in primary care settings; describes two representative case studies that illustrate locally customized collaborative care strategies for treatment delivery; and concludes with principles and implications for policy and practice based on our practical experiences.

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“…The Chronic Care Model highlights the importance of a population-based approach; involving community, patients and providers; and information technology [4][5][6] . Various combinations of population management, practice support, and patient outreach have been used for diabetes care in a variety of settings with mixed results [7][8][9][10][11][12][13][14][15][16] .…”

mentioning

confidence: 99%

The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

et al. 2009

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BACKGROUND:Optimal care for patients with diabetes is difficult to achieve in clinical practice. OBJECTIVE:To evaluate the impact of a registry and decision support system on processes of care, and physiologic control.PARTICIPANTS: Randomized trial with clustering at the practice level, involving 7,412 adults with diabetes in 64 primary care practices in the Northeast. INTERVENTIONS:Provider decision support (reminders for overdue diabetes tests, alerts regarding abnormal results, and quarterly population reports with peer comparisons) and patient decision support (reminders and alerts). MEASUREMENTS AND MAIN RESULTS:Process and physiologic outcomes were evaluated in all subjects. Functional status was evaluated in a random patient sample via questionnaire. We used multiple logistic regression to quantify the effect, adjusting for clustering and potential confounders. Intervention subjects were significantly more likely to receive guideline-appropriate testing for cholesterol (OR=1.39; [95%CI 1.07, 1.80] P=0.012), creatinine (OR=1.40; [95%CI 1.06, 1.84] P=0.018), and proteinuria (OR=1.74; [95%CI 1.13, 1.69] P=0.012), but not A1C (OR=1.17; [95% CI 0.80, 1.72] P = 0.43). Rates of control of A1C and LDL cholesterol were similar in the two groups. There were no differences in blood pressure, body mass index, or functional status. CONCLUSIONS:A chronic disease registry and decision support system based on easily obtainable laboratory data was feasible and acceptable to patients and providers. This system improved the process of laboratory monitoring in primary care, but not physiologic control.

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Quality Improvement in Chronic Illness Care: A Collaborative Approach

Cited by 535 publications

References 16 publications

Investigating the sustainability of outcomes in a chronic disease treatment programme

Investigating the sustainability of outcomes in a chronic disease treatment programme

Implementation of Guideline-Based Care for Depression in Primary Care

The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

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