Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114404

Van Dunn, MD, MPH¹, Louis Capponi, MD², Madhavi Patt, MD, MPH³, Mike Hindmarsh, MA⁴, Edward Wagner, MD, MPH⁵, and Karen Scott Collins, MD, MPH³. (1) Medical & Professional Affairs, New York City Health and Hospitals Corporation, 125 Worth Street, New York, NY 10013, 212 788-3648, dunnv@nychhc.org, (2) School of Medicine, New York University, 462 First Avenue, New York, NY 10016, (3) Health Care Quality, NYC Health and Hospitals Corporation, 346 Broadway suite 1111, New York, NY 10013, (4) MacColl Institute, GroupHealth Cooperative, 1730 Minor Avenue, suite MPE-1290, Seattle, WA 98101-1448, (5) Health Promotion Research Center, University of Washington, box 354804, Seattle, WA 98195

Chronic diseases contribute significantly to death and disability and are disproportionately present in minority and low income communities such as those served by the New York City Health and Hospitals Corporation (HHC). As with many health care delivery systems, optimal care is often hindered by lack of regular care, continuity, and communication between patient and providers; usual care typically relies on the patient to come in, rather than the provider taking a pro-active approach. This often leads to missed opportunities to identify disease or complications at the earliest, most treatable stages. Diabetes and heart failure are chronic conditions for which there is strong evidence that putting key changes into practice can improve patient outcomes. HHC is NYC's Public Hospital System, and cares for over 1.3 million New Yorkers annually at 11 hospitals and 6 diagnostic and treatment centers. In fall 2003, HHC launched a Chronic Disease Collaborative seeking to re-design clinical office practice at ambulatory care settings throughout HHC. The Collaborative began with 17 Teams working on diabetes and heart failure. HHC utilized the Chronic Care Model (CCM) developed by Ed Wagner, MD to improve patient –provider interactions through changes in: 1) ‘Delivery System Design' 2) ‘Self-Management Support' 3) ‘Decision Support' 4) clinical information systems, 5) ‘Health Care Organization' and 6) ‘Community Health Resources. Teams have tested and evaluated numerous changes throughout the system to achieve collaborative goals specific to national guidelines for diabetes and heart failure care. Some of the key changes implemented by the Teams: 1) planned visits, with pre and post-visit follow-up; 2) strong self-management support using goal sheets, action plans, etc.; 3) evidence-based guidelines were integrated into the daily work flow; 4) ‘fast-track' and mini-visits; 5) chronic disease registries designed and utilized for patient care. Improvements realized for Collaborative patients in the first year include: 1) % of diabetic patients with LDL<100 increased from 35% to 63%; (ii) % of patients with A1C<7 increased from 30% to 42%; (iii) patients with blood pressure 130/80 increased from 31% to 57%; (iv) annual monofilament testing increased from 12% to 73%; (v) annual retinal exam increased from 51% to 65%; and (vi) documented self-management plans increased from 19% to 72% of patients; and 2) for Heart Failure Patients, % of appropriate patients on ACE-Inhibitors and Beta-blockers above 90 percent. Next steps for the corporation are to take the most promising changes in practice and implement broadly across all clinics.

Learning Objectives:

• Describe key changes utilized to improve chronic care at a public hospital system
• Evaluate the effect of those changes on the health outcomes of patients with chronic disease

Keywords: Chronic Diseases, Quality Improvement

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation