Development and Implementation of a Collaborative Team Care Model for Effective Insulin Use in an Academic Medical Center Primary Care Network.
Improving glycemic control across a primary care diabetes population is challenging. This article describes the development, implementation, and outcomes of the Diabetes Care Collaborative Model (DCCM), a collaborative team care process focused on promoting effective insulin use targeting patients with hyperglycemia in a patient-centered medical home model. After a pilot, the DCCM was implemented in 18 primary care practices affiliated with an academic medical center. Its implementation was associated with improvements in glycemic control and increase in insulin prescription longitudinally and across the entire population, with a >1% reduction in the proportion of glycated hemoglobin >9% at 2 years after the implementation compared with the 2 years prior ( P < .001). Facilitating factors included diverse stakeholder engagement, institutional alignment of priorities, awarding various types of credits for participation and implementation to providers, and a strong theoretical foundation using the principles of the collaborative care model.
1 Massachusetts General Hospital, Boston, MA.|2 Harvard Medical School, Boston, MA.
Stephanie A
SA
Eisenstat
1 Massachusetts General Hospital, Boston, MA.|2 Harvard Medical School, Boston, MA.
Yuchiao
Y
Chang
1 Massachusetts General Hospital, Boston, MA.
Bianca C
BC
Porneala
1 Massachusetts General Hospital, Boston, MA.
Elizabeth
E
Geagan
1 Massachusetts General Hospital, Boston, MA.
Gianna
G
Wilkins
3 MGH Chelsea Health Center, Chelsea, MA.
Barbara
B
Chase
1 Massachusetts General Hospital, Boston, MA.
Sandra M
SM
O'Keefe
2 Harvard Medical School, Boston, MA.|4 MGH Diabetes Center and Center for Diabetes Population Health, Boston, MA.
Linda M
LM
Delahanty
1 Massachusetts General Hospital, Boston, MA.|2 Harvard Medical School, Boston, MA.
Steven J
SJ
Atlas
2 Harvard Medical School, Boston, MA.|5 MGH Laboratory of Computer Science, Boston, MA.
Adrian H
AH
Zai
1 Massachusetts General Hospital, Boston, MA.|2 Harvard Medical School, Boston, MA.
David
D
Finn
1 Massachusetts General Hospital, Boston, MA.|2 Harvard Medical School, Boston, MA.
Eric
E
Weil
2 Harvard Medical School, Boston, MA.|4 MGH Diabetes Center and Center for Diabetes Population Health, Boston, MA.
Deborah J
DJ
Wexler
D000046:Academic Medical Centers; D000368:Aged; D001786:Blood Glucose; D003299:Cooperative Behavior; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007318:Inservice Training; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
accountable care organization; care redesign; diabetes quality improvement; effective insulin use; insulin treatment; patient-centered medical home; type 2 diabetes