The Program Being Evaluated
Improving Chronic Illness Care (ICIC) is a national program dedicated to improving the quality of life among the 133 million Americans who suffer from diabetes, depression and other chronic conditions.
For a decade, ICIC has worked with national partners, funded studies and provided technical assistance to help health systems—especially those that serve low-income populations—amend their care through implementation of the Chronic Care Model (CCM). The CCM identifies the essential elements of a health care system that encourage high-quality chronic disease care, including the community, the health system, self-management support, delivery system design, decision support and clinical information systems.
About the Evaluation
When The Robert Wood Johnson Foundation authorized ICIC, it mandated that a rigorous independent evaluation of the collaborative improvement process and the implementation of the CCM by health systems be included. In 1999, a multidisciplinary research team from RAND and the University of California at Berkeley, in cooperation with ICIC, undertook the evaluation work. The lead evaluator for this program was Emmett B. Keeler, Ph.D., of RAND Corporation. The RAND study was designed to provide practical guidance to health care organizations seeking to improve care for patients with chronic disease. The evaluation team conducted consistent, independent assessments across participating sites.
Major Evaluative Topics and Questions
The evaluation addressed the following critical questions about organizational efforts to implement changes and improve care:
- Are organizations enrolled in the Collaborative able to make significant changes in their systems for delivering chronic illness care?
- What organizational and team factors are associated with successful change efforts?
- Does successful implementation of the CCM lead to better processes and outcomes of care, including patient health status, patient and provider satisfaction, utilization and costs?
Summary of Methods
During the following four years, the evaluation team conducted in-depth assessments across 51 participating sites in four collaboratives involving almost 4,000 patients with diabetes, congestive heart failure (CHF), asthma and depression. Methods included health care organization surveys, patient telephone surveys, patient chart review, senior leader reports and telephone interviews, and cost surveys.
Knowledge and Impact
More than 15 papers have been published detailing what was learned from the evaluation and a summary of each can be found linked below.
Highlights of the findings include:
- Organizations were able to improve, making an average of 48 changes in 5.8 out of the 6 CCM areas;
- Patients with diabetes had significant decreases to their risk of cardiovascular disease;
- CHF pilot patients more knowledgeable and more often on recommended therapy, had 35 percent fewer hospital days;
- Asthma and diabetes pilot patients were more likely to receive appropriate therapy.
When contacted a year later, the care teams reported that involvement in the collaboratives was rewarding. Over that year, 82 percent of sites had sustained the changes and 79 percent of sites had spread change to other places or diseases.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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