title: An asthma and diabetes quality improvement project: enhancing care in clinics and community health centers.
abstract: Asthma and diabetes are major chronic conditions in the United States, particularly in the Medicaid population. The majority of care for these diseases occurs at ambulatory practice sites. The New York State Department of Health Office of Health Insurance Programs (OHIP) worked with IPRO, the New York State Medicare quality improvement organization, to develop and implement a quality improvement project (QIP) for these conditions. The approach was based upon the Chronic Care Model and used an iterative academic-detailing methodology. Clinics and community health centers volunteered to participate and used IPRO-collected data with audit and feedback to improve their practices. Several metrics significantly improved for asthma (e.g., use of anti-inflammatory long term controller agents, assessment of asthma severity, use of asthma action plans) and for diabetes (e.g., lipid testing and control, A1c testing). Key organizational elements of success included senior medical leadership commitment and practice site quality improvement team meetings. OHIP has used the QIP experience to begin patient-centered medical home implementation in New York State.
authors.affiliation: IPRO Health Care Quality Improvement Team, 1979 Marcus Ave., Lake Success, NY 11042, USA. asilver@ipro.org
authors.forename: Alan
authors.initials: A
authors.lastname: Silver
authors.forename: James
authors.initials: J
authors.lastname: Figge
authors.forename: Donna L
authors.initials: DL
authors.lastname: Haskin
authors.forename: Veronica
authors.initials: V
authors.lastname: Pryor
authors.forename: Karen
authors.initials: K
authors.lastname: Fuller
authors.forename: Thomas
authors.initials: T
authors.lastname: Lemme
authors.forename: Nancy
authors.initials: N
authors.lastname: Li
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003151:Community Health Centers / Q000458:organization & administration*; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007373:Interinstitutional Relations; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009518:New York; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D055815:Young Adult