Applying the Chronic Care Model to Diabetes Management in the Primary Care Setting: Results of a Web-based Quality Improvement Program

Background: According to the American Diabetes Association, diabetes affects nearly 18 million people-more than 5% of the U.S. population-have been diagnosed with diabetes. As a result, diabetes is the fifth-deadliest disease in the United States. Closing the Gap (CTG): Diabetes Care is a team-based quality improvement program offered by the American College of Physicians. CTG was developed to a) identify and address gaps in knowledge related to diabetic patient care among primary care physicians and their staff members and b) teach physicians and their office team to apply the Chronic Care Model (CCM) and Plan-Do-Study-Act (PDSA) Cycle for Improvement to their day-to-day practice. Expert-led introductory conference calls offered program participants both didactic presentations and question-and-answer sessions, while advanced calls provided one-on-one coaching on participants' quality improvement plan implementation. Practice teams pulled data from two random samplings of 35 patients before and after completion of the CTG web-based educational intervention. Real-time data reports were provided to the practices to assist in the development and assessment of their quality improvement strategies and plans. Methods: De-identified patient data was collected through the use of a standardized electronic data abstraction form. Baseline data was collected prior to the introductory conference call and follow-up data collection approximately 4-6 months after implementation of the quality improvement plan. Results: A total of 28 teams (71 healthcare professionals in total) completed baseline and follow-up data on a total of 1,511 patients with diabetes. Chi-square analysis and T-test were used to measure improvement within select process and clinical outcome measures. The percentage of patients with documentation of dilated eye exams (71.2% to 82.9%) and proteinuria (74.5% to 82.5%) was significantly increased post-educational intervention, while there was a trend towards an increased percentage of patients with a documented foot exam (82.3% to 85.6%). The intervention also increased the percentage of patients receiving the influenza vaccine (63.1% to 74.4%), being treated with ACE inhibitors or AR blockers (80.5% to 87.4%), and lowered HbA1c values (8.2 to 7.8). Conclusion: This study illustrates notable differences in several process and outcome measures for diabetes care following intervention. With an extended intervention period beyond the 6 months used in this study, it may become possible to capture additional significant outcomes. Overall, we conclude that this multi-faceted approach to applying the Chronic Care Model in the primary care setting contributed to these positive findings.