title: Improved clinical outcomes for fee-for-service physician practices participating in a diabetes care collaborative.
abstract: BACKGROUND
  The Rockwood Clinic in Spokane, Washington, participated in the Washington State Diabetes Collaborative, which promoted spread of the Chronic Care Model. Eleven participating providers managed care for 698 patients with diabetes, while 19 non-participating providers had 1,300 patients. IMPLEMENTING THE CHRONIC CARE MODEL: Rockwood upgraded its clinical information system to allow for creation of a patient registry to track clinical measures and generate performance reports. Components included a referral mechanism to facilitate more frequent use of diabetes educators, monthly reports, and sharing of results and updated clinical information from consulting specialists. Rockwood created a self-management tool kit and implemented patient goal setting and group visits.
  
  
  METHODS
  Seven of the 12 patient outcomes were significantly better for participating providers (p < .05). Two favorable outcomes, eye examinations and blood pressure < 130/85 mm Hg, were significantly associated with greater participation levels at p < .05.
  
  
  CONCLUSIONS
  Implementing the Chronic Care Model to improve care, using quality improvement staff and administrative support, required fundamental changes in the system of care delivery. These changes were designed to refocus diabetes care efforts at Rockwood on prevention rather than acute care episodes.
authors.affiliation: Rockwood Clinic, Spokane, Washington, USA. rbenedetti@rockwoodclinic.com
authors.forename: Rob
authors.initials: R
authors.lastname: Benedetti
authors.forename: Barb
authors.initials: B
authors.lastname: Flock
authors.forename: Steve
authors.initials: S
authors.lastname: Pedersen
authors.forename: Melissa
authors.initials: M
authors.lastname: Ahern
mesh_terms: D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000628:therapy; D003299:Cooperative Behavior; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D018588:Fee-for-Service Plans / Q000592:standards*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care / Q000592:standards*; D010353:Patient Education as Topic; D019984:Quality Indicators, Health Care; D012042:Registries; D014481:United States; D015351:Vision Screening / Q000706:statistics & numerical data; D014861:Washington