A state-level application of the chronic illness breakthrough series: results from two collaboratives on diabetes in Washington State.
BACKGROUND
Breakthrough Series Collaboratives addressing chronic conditions have been conducted at the national level and in single health care delivery systems but not at the state level. Two state-level collaboratives were conducted: Diabetes Collaborative I (October 1999-November 2000) included 17 clinic teams from across the state, and Diabetes Collaborative II (February 2001-March 2002) included 30 teams and 6 health plans.


METHODS
Both collaboratives took place in Washington State, where a diverse group of primary care practices participated, and health insurance plans partnered with the clinic teams. Teams individually tested and implement changes in their systems of care to address all components of the Chronic Care Model.


RESULTS
All 47 teams completed the collaboratives, and all but one maintained a registry throughout the 13 months. Most teams demonstrated some amount of improvement on process and outcome measures that addressed blood sugar testing and control, blood pressure control, lipid testing and control, foot exams, dilated eye exams, and self-management goals.


CONCLUSIONS
The benefits of holding collaboratives more locally include increased technical support and increased participation, translating into wider implementation of prevention-focused, patient-centered care.
Daniel
Donna M
DM
Qualis Health, Seattle, USA. donnad@qualishealth.org
Norman
Jan
J
Davis
Connie
C
Lee
Helan
H
Hindmarsh
Michael F
MF
McCulloch
David K
DK
Wagner
Edward H
EH
Sugarman
Jonathan R
JR
D002908:Chronic Disease; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D007348:Insurance, Health; D007591:Joint Commission on Accreditation of Healthcare Organizations; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care; D012648:Self Care; D014481:United States; D014861:Washington