Brian T. Austin

Organizing Care for Patients with Chronic Illness

Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.

Evidence On The Chronic Care Model In The New Millennium

Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCMs effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes.

Elements of Effective Chronic Care: A Model for Optimizing Outcomes for the Chronically Ill

Current estimates are that there are 2.3 million individuals with epilepsy among 99 million Americans suffering from chronic medical conditions. The healthcare system is designed to treat acutely ill patients and, as a result, often fails to meet the needs of the chronically ill. Care is provided in brief, problem-focused visits. Multiple studies have shown that this type of standard practice produces suboptimal care and outcomes, and is unsatisfactory to both patients and care providers. We developed the Chronic Care Model in an effort to synthesize system and practice changes associated with better outcomes. In patient care as described in this model, patient-provider interactions are planned in advance in accordance with evidence-based guidelines. A primary focus is on assisting patients and their families in becoming competent self-managers. The Chronic Care Model has been successfully implemented by more than 200 healthcare systems. In this paper, we explore the applicability of the Chronic Care Model in managing patients with epilepsy.

Development of a facilitation curriculum to support primary care transformation: the "coach medical home" curriculum.

Background:In an effort to improve patient care, retain high-quality primary care providers, and control costs, primary care practices across the United States are transforming to patient-centered medical homes. This is no small task. Practice facilitation, also called “coaching,” is increasingly being used to support system change; however, there is limited guidance for these programs. Objective:To develop an evidence-based curriculum to help practice coaches guide broad-scale transformation efforts in primary care. Methods:We gathered evidence about effective practice transformation coaching from 25 published programs and 8 expert interviews. Given limited published information, we drew extensively on our experience as leaders and coaches in the Safety Net Medical Home Initiative. Using these data, and with input from a User Group, we identified 6 curricular topics and created learning objectives and curricular content related to these topics. Results:The Coach Medical Home curriculum guides coaches in the following areas: getting started with a practice; recognition and payment; sequencing changes; measurement; learning communities; and sustainability and spread. Conclusions:Coach Medical Home is a publically available web-based curriculum that provides tools, resources, and guidance for practice transformation support programs, including practice facilitators and learning community organizers.

PS1-38: Catalyzing Innovation at the Front Lines of Health Care

Background/Aims: To find new ways for Group Health, its research center and its community foundation to work together, we pilot tested the Partnership for Innovation, a grant program to encourage and seed organization wide innovation. Innovation is defined as new ideas or approaches that have the potential to add value and change the way the organization works. The program gives staff funding to develop, implement, and evaluate innovations within the healthcare system. Evaluations assess the effect of the innovations in terms of costs, patient satisfaction, organizational readiness, and other aspects. These results inform decisions about adopting the innovation organization wide. Methods: We disseminated an initial call for proposals to medical center leaders, and developed a two-step selection process in which we first reviewed brief concept proposals for their innovativeness, likely effectiveness, impact, feasibility, congruence with strategic priorities, and overlap with other efforts. We next invited selected applicants to expand their proposals for review by the program’s steering committee. In step three, the Partnership program itself was refined and improved through Plan-Do- Check-Act cycles after each of the two funding rounds in 2008. Results: We received 19 proposals in 2008 (12 in the first round). Funded proposal topics included nasal flu vaccine for children, an online chronic disease self-management program, infectious disease management for long-term care facilities, and enhancing medication safety for patients with complex medication regimens. The first round of four pilots are currently underway and the second round of two funded pilots will begin in 2009. Viable but unfunded proposals were rerouted to other departments to encourage discussion about whether the idea could be developed through other channels. Conclusions: Offering a pilot grant program to frontline staff may enhance engagement, empowerment, and creativity. Evaluating the pilot programs is an essential component of this initiative, both to improve the pilots themselves, and the innovation program as a whole. The partners found the collaboration promising and worth continued funding in 2009.