Adoption, Sustainability and Spread of Self-Management Supports

The Program Being Evaluated

In September 2005, the Institute for Healthcare Improvement (IHI) launched a national initiative called Quality Allies: Improving Care by Engaging Patients, a collaborative effort by the Robert Wood Johnson Foundation (RWJF) and the California HealthCare Foundation. Quality Allies was a collaborative learning community designed to demonstrate that innovative, comprehensive patient- and family-centered models for chronic illness self-management could be delivered in primary care and community settings and would significantly improve patient outcomes. Building on Quality Allies, New Health Partnerships: Improving Care by Engaging Patients (NHP) was launched in March 2007. NHP was designed as a virtual learning community having the potential to address logistical barriers of learning and spread of self-management supports such as travel and accommodating large numbers of providers and patients.

About the Evaluation

This evaluation of the Quality Allies and NHP learning communities focused on the second and third phases of a national initiative of RWJF. Quality Allies utilized face-to-face learning sessions, while NHP explored providing quality improvement around self-management supports through a “virtual learning” format. The evaluation specifically focused on documenting the impact of the initiatives on systems of clinical care delivery and on patient outcomes. The lead evaluator was Seth Emont, Ph.D., M.S., White Mountain Research Associates, L.L.C.

The evaluation sought to:

  • document the extent to which new “change processes” were used in these primary care sites to facilitate the use of self-management support, and the role of patients and family members in facilitating these changes;
  • examine the extent to which participation in the learning communities facilitated the adoption, sustainability and spread of self-management support services among participating sites; and
  • document long-term success in patient perceptions of care, health behavior and clinical outcomes.

Summary of Methods

A quality improvement survey, the Primary Care Resources and Support Survey, was administered at baseline and follow-up. An online survey focused on implementation and sustainability of changes surrounding self-management support. In-depth telephone interviews were conducted with team leaders at the end of the program. Additionally, the evaluators gathered data through patient surveys, goal examination and clinical outcome measures.

Knowledge and Impact

Results indicated that teams from the learning communities did initiate many types of change in approach and delivery of patient care. Overall findings suggest that a virtual format may be a more cost-effective approach to training. Frequently cited barriers to the initiative included reimbursement for diabetes self-management support training and related services and making a “business case” for self-management supports.