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Sustainability and Spread of Chronic Illness Care Improvement

Sustainability and Spread of Chronic Illness Care Improvement. Shinyi Wu 1 (shinyi@rand.org) M. L. Pearson 1 , S. M. Shortell 2 , P. J. Mendel 1 , J. A. Marsteller 3 , M. K. Lin 2 E. B. Keeler 1. 1 RAND Health 2 School of Public Health, UC Berkeley 3 National Center for Health Statistics.

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Sustainability and Spread of Chronic Illness Care Improvement

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  1. Sustainability and Spread of Chronic Illness Care Improvement Shinyi Wu1 (shinyi@rand.org) M. L. Pearson1, S. M. Shortell2, P. J. Mendel1, J. A. Marsteller3, M. K. Lin2 E. B. Keeler1 1RAND Health 2School of Public Health, UC Berkeley 3National Center for Health Statistics June 7, 2004

  2. Chronic Care Model Collaborative • CCM/IHI Collaboratives: • Multi-faceted interventions to improve systems of care as well as individual provider behavior • see: http:// improvingchroniccare.org • ICICE: • Evaluation of QI effectiveness • see:http://www.rand.org/health/ICICE • Funded by the RWJF

  3. Quality Improvement: Built to Last? • Objectives of the study • To assess the sustainability and spread of CCM implementation efforts • To examine their relationships with CCM implementation intensity

  4. Participating Organizations * One outlier 57% are single organization. 45% are publicly-funded. 86% are providers (vs. plans). 67% are outpatient providers.

  5. Measures of Sustainability and Spread • Data sources • Telephone interviews with key informant(s) • Coded monthly reports and meeting materials submitted by the organizations • Measures • Sustainability: post-collaborative status of the QI activities • Expanded (coded as 2) • Maintained at collaborative level only (1) • Declined or drifted (0) • Spread: self-reported success at spread • Any (Yes or no, coded as 1 and 0) • Type (7 categories of spread)

  6. Continuation and Successful Spread Spread Expanded Collaborative level No spread Decline

  7. Type of Spread

  8. Bivariate correlations Ordinal regressions :1) Sustainability 2) Spread Controlled for disease. Each independent variable is fitted separately. Analysis of Relationships with Implementation

  9. Health System Organization Leadership commitment to quality Self-Management Support Skilled clinical educators Psychosocial support Change plans Delivery System Design Nurse case manager Planned follow-up Decision Support Feedback Guidelines Consultation Clinical InformationSystems Registry Reminders Measurement + Links to Community Resources Productive Interactions Informed, Activated Patient Prepared Practice Team Better Functional and Clinical Outcomes A Model for Chronic Illness Care

  10. 0.35* 0.34* 0.56** 0.37* 0.36* 0.25 0.30†0.28† Quantity of Implementation 0.51** †P < .10 * P < .05 ** p < .01 Depth of Implementation 0.47** QI Sustainability and CCM Implementation Bivariate Correlations with Quantity and Depth of CCM Implementation Health System Organization 0.43** 0.57** Self-Management Support Delivery System Design Decision Support Clinical InformationSystems + Links to Community Resources 0.12 0.18 Greater Continuation of Chronic Care Improvement

  11. 0.23 0.30† 0.40** 0.38* 0.22 0.11 0.32* 0.29† Quantity of Implementation 0.40* †P < .10 * P < .05 ** p < .01 QI Spread and CCM Implementation Bivariate Correlations with Quantity and Depth of CCM Implementation Health System Organization 0.43** 0.37* Self-Management Support Delivery System Design Decision Support Clinical InformationSystems + Links to Community Resources 0. 01 -0.05 Depth of Implementation 0.35* Greater Success in Spreading Chronic Care Improvement

  12. Critical Areas of CCM for Sustainability and Spread Based on ordinal regressions. < .10 < .05 < .01

  13. Summary • One year later, most health organizations report sustaining and spreading the CCM change efforts. • Keys to sustaining chronic care improvement and facilitating successful spread: • Intensively implement CCM during the collaborative period • Acquire health system support • Reorganize delivery system • Build clinical information system • Increase decision support capabilities • Provide self-management support

  14. Implications for Quality Improvement Chronic care improvement can be sustained after the intervention period and successfully spread to other areas. To sustain and spread CCM changes, collaborative and organizational leaders should promote change efforts (in both quantity and depth) during the initial collaborative period.

  15. Thank you!

  16. Influence of Disease Focus on Sustainability Chi-square test p <.05 Asthma CHF

  17. Influence of Disease Focus on Spread Chi-square test p <.05 Asthma CHF

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