A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices

The Academic Chronic Care Collaboratives (ACCCs) implemented the Chronic Care Model (CCM) in teaching hospitals in California and throughout the U.S.

U.S. physicians receive insufficient training in evidence-based treatment for chronic illness. The Chronic Care Model (CCM) is an evidence-based strategy for chronic illness care. CCM has improved chronic illness care in community clinical settings.

This report, from a supplement to the Journal of General Internal Medicine, describes two initiatives that implemented CCM in U.S. teaching hospitals. Thirty-six teams in 22 U.S. teaching hospitals participated in the national Academic Chronic Care Collaborative (2005-2006); 15 teams in the national collaborative focused on diabetes improvement. Twenty-one additional teams from 15 teaching hospitals in California took part in the California Academic Chronic Care Collaborative (2007-2008); 15 teams in the California initiative addressed diabetes care.

The ACCCs had two goals: 1) to redesign–using CCM–training for residents who treat chronic illness; and, 2) to improve chronic illness care itself within each teaching hospital. Residency institutions completed self-evaluations at the beginning, middle and end of the ACCCs. National faculty met openly with team members to review the evaluations.

Key Findings:

  • From start to finish in both initiatives, there was progressive implementation of CCM.
  • Teaching hospitals extensively modified their teaching processes.
  • Teams that focused on diabetes care saw significant improvements in health outcomes.

The majority of patients treated during the ACCCs faced significant impediments to the continuity of care. These obstacles included: limited financial means; lack of transportation; and medication costs. A limitation to this study was the absence of a control group, therefore, the authors cannot definitively attribute improvements in clinical outcomes to CCM. The Chronic Care Model was developed as the result of Improving Chronic Care, a national program funded by the Robert Wood Johnson Foundation between May 1998 and December 2009.