HRSA's Bureau of Primary Health Care has been implementing a 6-yr Breakthrough Series to improve care of chronic illness in community health centers (CHCs) that serve the indigent. The intervention consists of Rapid Plan-Do-Study-Act cycles from CQI, Wagner Chronic Care Model (patient self-management, decision support, clinic redesign, information systems, community outreach, organization leadership), and regional team learning sessions. We evaluated effectiveness and implementation challenges during the first year of the Diabetes Breakthrough Series.
Among 19 Midwest CHCs, we performed chart reviews (80 random patients from entire diabetic population/CHC), surveyed providers (66% response rate) and performed semi-structured interviews of participants. We used hierarchical regression modeling.
Between 1998 and 1999, performance of diabetes processes of care improved (P < .05): at least 2 Hgb A1c tests measured at least 3 months apart (38% to 54%), eye exam referral (37% to 50%), foot exam (40% to 65%), lipid assessment (56% to 67%). 94% of providers agreed that the initiative was successful and worth the effort. Interviews and survey indicated: 1) Chronic care model well-liked; 2) Rapid PDSA cycles often done qualitatively; 3) Data collection, patient registry burdensome but useful; 4) Senior administrative support and local champion crucial; 5) Lack of computer information systems major early barrier; 6) Need time for CQI activities; 7) Staff turnover challenging; 8) Nurturing of spirit helpful; 9) Ability to sustain QI gains of concern.
A modified CQI, chronic care management approach led to improvements in the quality of care. Efforts to sustain and increase these gains must continue.
Learning Objectives: At the conclusion of the session, the learner will be able to: 1) Describe the Breakthrough Series method of improving diabetes care in community health centers 2) Report the results of an evaluation of this quality improvement intervention 3) Discuss challenges in improving the care of patients with diabetes in health centers
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Bureau of Primary Health Care
Institute for Healthcare Improvement
MacColl Institute
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Grant from Bureau of Primary Health Care