142nd APHA Annual Meeting and Exposition

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Crescent City Beacon Community: Innovations in chronic care management and transitions of care

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 10:30 AM - 10:50 AM

Heather Farb, MPH , Louisiana Public Health Institute, New Orleans, LA
Alexandra Priebe, PhD(c), MPH, MA , Division of Evaluation and Research, Louisiana Public Health Institute, New Orleans, LA
Chatrian Kanger, MPH , Division of Evaluation, Louisiana Public Health Institute (LPHI), New Orleans, LA
Amanda Carruth , Health Systems Division, Louisiana Public Health Institute, New Orleans, LA
Lisanne Brown, PhD MPH , Division of Evaluation and Research, Louisiana Public Health Institute, New Orleans, LA
Anjum Khurshid, MBBS, PhD , Health Systems Development, Louisiana Public Health Institute, New Orleans, LA
Audio (mp3) recording Recorded Presentation (mp4)
Background: The Crescent City Beacon Community (CCBC) aimed to reduce the burden of diabetes (DM) and cardiovascular disease (CVD) in the Greater New Orleans area by engaging safety net community health centers in implementing chronic care management interventions and improving transitions of care through a learning collaborative. CCBC sequentially implemented the following interventions: care management/care team strategies, population-based disease registries, risk stratification, clinical decision support (CDS), transitions of care (TOC), and quality measurement and performance reporting. 

Methods: This study used a mixed methods design to examine the experiences of participating health centers in implementing chronic care management and TOC interventions as well as to demonstrate the extent to which they were able to improve DM and CVD quality measures and outcomes.Four centers were purposively selected for in-depth case studies to explore differences within and between cases. Quantitative findings from a measures-focused assessment, program records, and in-depth interviews of providers and patients were analyzed.

Results: Centers were stratified based on their baseline implementation scores in order to examine the variation in their progress during CCBC.  Tier 1 centers had the greatest improvements in establishing quality improvement initiatives and population management. Tier 2 centers had the greatest gains in risk stratification and CDS, while Tier 3 health centers made the most improvement in TOC.  

Qualitative data shows that centers adopted the interventions in different ways; for example, Center A created risk-stratified registries and wrote protocols for their DM and CVD patients while Center B instituted group visits. The centers made the greatest progress in the areas of TOC, development and deployment of written care plans, and training staff on appropriate use of CDS tools. The centers demonstrated improved health outcomes of HbA1c control <8.0% (increased from 49% to 58%) and LDL control <100 (increased from 37% to 40%) from December 2011 to January 2013. Centers attributed these improvements to their care teams and care management. Both providers and patients recognized the importance of care management in improving care quality, coordination, and patient outcomes.  All of the centers reported spreading clinical transformation tools and processes to other areas of their practices.

Conclusions:  Successful clinical transformation requires sequenced implementation of interventions that build up on each other. CCBC has demonstrated how chronic care management and TOC lead to improved processes and outcomes. In spite of these demonstrated improvements, several centers reported challenges in sustaining interventions, particularly care management.

Learning Areas:

Administer health education strategies, interventions and programs
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Describe how Crescent City Beacon Community (CCBC) interventions led to clinical transformation and improved patient outcomes. Discuss how variation in the implementation of CCBC interventions affected DM and CVD quality measures and outcomes.

Keyword(s): Chronic Disease Management and Care, Patient-Centered Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-investigator on the case study and conducted many of the patient and provider interviews. I have also led components of the analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5127.0: Successful care transitions for optimal patient outcomes