Improving Chronic Illness Care a quick look at the CCM

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Improving Chronic Illness Carea quick look at
the CCM

• WA State Collaborative to Improve Health
• April 17, 2008

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Objectives

• Identify the six components that comprise the
  Chronic Care Model what they are and how they
  fit together.
  
• Summarize the current literature about practices
  that have implemented the Chronic Care Model.
  
• Describe what key changes a practice can make to
  improve care for their chronically ill patients.

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Chronic Illness in America

• More than 125 million Americans suffer from one
  or more chronic illnesses and 40 million limited
  by them.
  
• Despite annual costs of more than 1 trillion and
  significant advances in care, one-half or more of
  patients still dont receive appropriate care.
  
• Gaps in quality care lead to thousands of
  avoidable deaths each year.
  
• Patients and families increasingly recognize the
  defects in their care.

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Johns Hopkins U.S. Survey about Chronic Care
Agreeing
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The IOM Quality Chasm Report Conclusions
The current care systems cannot do the job.
Trying harder will not work.
Changing care systems will.
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To Change Outcomes Requires Fundamental Practice
Change

• Reviews of interventions in several conditions
  show effective practice changes are similar
  across conditions.
  
• Integrated changes with components directed at
• influencing physician behavior
• better use of non-physician team members
• enhancements to information systems
• planned encounters
• modern self-management support, and
• care management for high risk patients

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Chronic Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Improved Outcomes
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How would I recognize a productive interaction?
Prepared Practice Team
Informed, Activated Patient
Productive Interactions

• Assessment of self-management skills and
  confidence as well as clinical status
  
• Tailoring of clinical management by stepped
  protocol
  
• Collaborative goal-setting and problem-solving
  resulting in a shared care plan
  
• Active, sustained follow-up

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Vignettes
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Experience with Collaboratives

• More than 1,000 different health care
  organizations and various diseases involved to
  date
  
• Began with national BTS, now regional,
  state-based facility specific
  
• HRSAs Health Disparities Collaboratives-600
  community and migrant health centers, now
  academic medical centers small practices
  
• External evaluations of early efforts by Chin et
  al., RAND

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RAND Evaluation of Chronic Care Collaboratives

• Studied 51 organizations in four different
  collaboratives, 2132 BTS patients, 1837 controls
  with diabetes, CHF, asthma
  
• Controls generally from other practices in
  organization
  
• Data included patient and staff surveys, medical
  record reviews
  

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RAND Findings

• Organizations made average of 48 changes in 5.8/6
  CCM areas
  
• IT received most attention, community linkages
  the least
  
• CHF pilot patients more knowledgeable and more
  often on recommended therapy, had 35 fewer
  hospital days
  
• Asthma and diabetes pilot patients more likely to
  receive appropriate therapy.
  
• Asthma pilot patients had better QOL
• Diabetes had significantly better glycemic control

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RCTs of CCM-based interventions

• All but one shows implementation of the CCM
  significantly improves process and outcome
  measures compared to controls and when included
  in the trial less intensive interventions (e.g.
  physician training alone).
• Team motivation to change may be an important
  factor in predicting success.
  
• Preliminary evidence that collaboratives improve
  process measures at the end of 1 year and
  outcomes after 3 to 4 years.

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Challenges Remaining
Try less time- intensive learning
Reaching beyond early adopters
Create supportive systems
Target small practices
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Contact us at
www.improvingchroniccare.org