in morbidity and mortality of patients with diabetes was measured by proxy. The Arizona Diabetes Initiative (AzDIn), a statewide coalition of health care …
Health Services Advisory Group HSAG Helps Lead Collaborative Approach to
Improving Diabetes Care
Health Services Advisory Group HSAG, QIO for Arizona, helped to
coordinate the Arizona State Diabetes Collaborative ASDC - a health care
quality improvement project designed to improve chronic care and preventive
care for diabetes patients through partnership and efficient, evidence-
based practices The project received support from the Centers for Medicare
Medicaid Services CMS and the Robert Wood Johnson RWJ Foundation
The ASDC demonstrated significant improvements for over 3,000 patients in
twelve physician offices in diabetes-specific quality measures of
hemoglobin A1c A1c control, LDL control, and self-management The
objectives of the ASDC were to:
Promote adoption of Chronic Care Model CCM principles and
components, especially information and communications technology,
through diabetes QI activities
Create and foster multistakeholder QI activities by demonstrating the
power of aligned state and national diabetes QI activities
Create, assist, and promote a demographically and geographically
diverse provider core of innovators/early
adopters upon which to build
future CCM-based safety and QI activities
Expose primary care physicians-in-training to the CCM using the
Breakthrough Series Collaborative BTS approach
The project utilized the Institute for Healthcare Improvement IHI BTS
collaborative model and incorporated rapid cycle quality improvement
techniques Guided by expert faculty, ASDC teams learned how to apply the
CCM in their practice, tested methods to integrate systems change using
the Plan-Do-Study-Act [PDSA] model, and implemented tools and other
evidence-based interventions including electronic health registries to
accomplish their goals Practice settings consisted of private practices,
residency programs, and community health centers Urban, rural, and
underserved patients were represented
Outcomes Change in clinical measures, impact on current/future patient
health?
| |12 Collaborative Teams |
|Measure |June 2003 |April 2004 |
| |N 2,536 patients |N 3,327 patients |
|A1c 70 |3370 |3790 |
|LDL 100 mg/dl |4120
|4620 |
|BP 130/80 mm Hg |3210 |3280 |
|Self-Management |1480 |3170 |
|Dilated Eye Exams |4330 |– |
|Assessment Scale |18 |34 |
|ACIC Survey |52 |7 |
Data Source: Team registries, all available data used each time period
All changes were statistically significant p 05 excepting BP;
significance testing is at the patient level
ASDC post-project eye exam data incomplete at time of final report For
comparison purposes, the CMS Dashboard reflects a 64 to 69 improvement
for Arizona statewide, and a 728 to 745 improvement for the Intensive
Participants for Eye Exams
Reduction in morbidity and mortality of patients with diabetes was measured
by proxy A reduction in A1c test values of one percent correlates with 25
percent reduction in mortality Based on the collaborative teams that
measured reduction in average A1c percentages for participating patients
n 817, a significant improvement was demonstrated Average rates
decreased from 785 percent at baseline to 747 percent at
remeasurement, a
positive change of 038 percent with an estimated impact of 95 percent
reduction in mortality
Upon completion of the learning sessions, the ASDC teams continued to
engage in the collaborative process by entering data, using the registry
tools, participating in monthly team teleconferences, implementing PDSA
cycles, sustaining and spreading efforts to other indicators, and
participating in other QI initiatives
Examples of the impact of the ASDC among public and private sector
stakeholders include the following:
National expert faculty in evidence-based medicine, information
technology IT, and QI provided mentoring to the ASDC, thus lending
to accelerated culture change and increased provider interest and
acceptance of the concepts and use of the CCM as the model for
improvement
The state Medicaid provider, Arizona Health Care Cost Containment
System AHCCCS, adopted the CCM framework including use of CCM
concepts as a requirement for its contracted health plans
Arizona Department of Health Services ADHS is developing a
comprehensive chronic disease strategic plan that incorporates the CCM
and endorses
ASDC-like activities
The Arizona Diabetes Initiative AzDIn, a statewide coalition of
health care professionals, managed care organizations, community
stakeholders, civic leaders, and media representatives that supported
ASDC activities via quarterly meetings, was spun off from the QIO, and
continues to exist as a self-sustaining, community stakeholder-led
activity
After concluding the project in the QIO 7SOW, HSAG continued to build
capacity in Arizona using the CCM The improved systems of care achieved by
the ASDC cohort will spread to reach the nearly 8,000 persons with diabetes
served by the collaborative team practices Efforts continued to engage
physician office teams, implement electronic registries, and expand
community interest in a regional information and communication technology
ICT network
HSAG continued to establish new partnerships with professional and
informatics organizations and pursue opportunities to assist providers with
the transition to electronic health records EHRs in the Medicare QIO
8SOW
Name/contact info for staff filling this out: Bill Staples, MBA, Executive
Director,
Communications
Source:ahqa.org
