title: A successful chronic care program in Al Ain-United Arab Emirates.
abstract: BACKGROUND
  The cost effective provision of quality care for chronic diseases is a major challenge for health care systems. We describe a project to improve the care of patients with the highly prevalent disorders of diabetes and hypertension, conducted in one of the major cities of the United Arab Emirates.
  
  
  METHODS
  The project, using the principles of quality assurance cycles, was conducted in 4 stages.The assessment stage consisted of a community survey and an audit of the health care system, with particular emphasis on chronic disease care. The information gleaned from this stage provided feedback to the staff of participating health centers. In the second stage, deficiencies in health care were identified and interventions were developed for improvements, including topics for continuing professional development.In the third stage, these strategies were piloted in a single health centre for one year and the outcomes evaluated. In the still ongoing fourth stage, the project was rolled out to all the health centers in the area, with continuing evaluation. The intervention consisted of changes to establish a structured care model based on the predicted needs of this group of patients utilizing dedicated chronic disease clinics inside the existing primary health care system. These clinics incorporated decision-making tools, including evidence-based guidelines, patient education and ongoing professional education.
  
  
  RESULTS
  The intervention was successfully implemented in all the health centers. The health care quality indicators that showed the greatest improvement were the documentation of patient history (e.g. smoking status and physical activity); improvement in recording physical signs (e.g. body mass index (BMI)); and an improvement in the requesting of appropriate investigations, such as HbA1c and microalbuminurea. There was also improvement in those parameters reflecting outcomes of care, which included HbA1c, blood pressure and lipid profiles. Indicators related to lifestyle changes, such as smoking cessation and BMI, failed to improve.
  
  
  CONCLUSIONS
  Chronic disease care is a joint commitment by health care providers and patients. This combined approach proved successful in most areas of the project, but the area of patient self management requires further improvement.
authors.affiliation: Ambulatory Health Care Services, SEHA, Al Ain, Abu Dhabi, United Arab Emirates. latifa.mohammad@gmail.com
authors.forename: Latifa M
authors.initials: LM
authors.lastname: Baynouna
authors.forename: Amal I
authors.initials: AI
authors.lastname: Shamsan
authors.forename: Tahira A
authors.initials: TA
authors.lastname: Ali
authors.forename: Lolowa A
authors.initials: LA
authors.lastname: Al Mukini
authors.forename: Moza H
authors.initials: MH
authors.lastname: Al Kuwiti
authors.forename: Thuraya A
authors.initials: TA
authors.lastname: Al Ameri
authors.forename: Nico J D
authors.initials: NJ
authors.lastname: Nagelkerke
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Abusamak
authors.forename: Nader M
authors.initials: NM
authors.lastname: Ahmed
authors.forename: Sanaa M Zein
authors.initials: SM
authors.lastname: Al Deen
authors.forename: Tariq M
authors.initials: TM
authors.lastname: Jaber
authors.forename: Abdulkarim M
authors.initials: AM
authors.lastname: Elkhalid
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Revel
authors.forename: Alhusini I
authors.initials: AI
authors.lastname: Al Husaini
authors.forename: Fouad A
authors.initials: FA
authors.lastname: Nour
authors.forename: Hayat O
authors.initials: HO
authors.lastname: Ahmad
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Nazirudeen
authors.forename: Rowaya
authors.initials: R
authors.lastname: Al Dhahiri
authors.forename: Yahya O Zain
authors.initials: YO
authors.lastname: Al Abdeen
authors.forename: Aziza O
authors.initials: AO
authors.lastname: Omar
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D003920:Diabetes Mellitus / Q000628:therapy; D006302:Health Services Research; D006801:Humans; D006973:Hypertension / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D015397:Program Evaluation; D017749:Total Quality Management / Q000592:standards*; D014479:United Arab Emirates