Quality improvement in chronic illness care: a collaborative approach.
BACKGROUND
Despite rapid advances in the clinical and psycho-educational management of diabetes, the quality of care received by the average patient with diabetes remains lackluster. The "collaborative" approach--the Breakthrough Series (BTS; Institute for Healthcare Improvement [IHI]; Boston)--coupled with a Chronic Care Model was used in an effort to improve clinical care of diabetes in 26 health care organizations.


METHODS
Descriptive and pre-post data are presented from 23 health care organizations participating in the 13-month (August 1998-September 1999) BTS to improve diabetes care. The BTS combined the system changes suggested by the chronic care model, rapid cycle improvement, and evidence-based clinical content to assist teams with change efforts. The characteristics of organizations participating in the diabetes BTS, the collaborative process and content, and results of system-level changes are described.


RESULTS
Twenty-three of 26 teams completed participation. Both chart review and self-report data on care processes and clinical outcomes suggested improvement based on changes teams made in the collaborative. Many of the organizations evidencing the largest improvements were community health centers, which had the fewest resources and the most challenged populations.


CONCLUSIONS
The initial Chronic Illness BTS was sufficiently encouraging that replication and evaluation of the BTS collaborative model is being conducted in more than 50 health care systems for diabetes, congestive heart failure, depression, and asthma. This model represents a feasible method of improving the quality of care across different health care organizations and across multiple chronic illnesses.
Wagner
E H
EH
MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative of Puget Sound, 1730 Minor Ave, Suite 1290, Seattle, WA, USA. wagner.e@ghc.org; www.improvingchroniccare.org
Glasgow
R E
RE
Davis
C
C
Bonomi
A E
AE
Provost
L
L
McCulloch
D
D
Carver
P
P
Sixta
C
C
D000368:Aged; D002908:Chronic Disease; D003299:Cooperative Behavior; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D006302:Health Services Research; D006801:Humans; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D010348:Patient Care Team; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*; D014481:United States