Toolkit for Implementing the Chronic Care Model in an Academic Environment
Creating the Business Case
Engaging hospital administrators in the Chronic Care Model approach is important for successfully transforming the health care system. The University of Cincinnati Academic Health Center and Vanderbilt University Medical Center emphasized the bottom-line benefits to build a convincing business case for adopting the Chronic Care Model.
Creating the Business Case—University of Cincinnati Academic Health Center
- Uncompensated care is reduced. The University of Cincinnati Academic Health Center's internal medicine team used hospital and clinic data gathered as a result of plan-do-study-act (PDSA) projects to demonstrate how the Chronic Care Model reduces emergency department visits and admissions for uninsured patients.
- The Chronic Care Model aligns with key hospital objectives. Cincinnati Children's Hospital Medical Center has a national reputation for its improvement work. The Chronic Care Collaborative was well aligned with the hospital's organizational strategy and viewed as a mechanism for further improving outpatient care and residency education.
- The Chronic Care Model addresses Accreditation Council for Graduate Medical Education (ACGME) requirements. Residency programs are working under six ACGME competencies that include System-Based Practice and Practice-Based Learning and Improvement. A chronic care collaborative fits well within these aims, and offers a proven approach for improving resident education.
- Chronic Care Model projects can enhance resident recruitment. Increasingly, residents are interested in novel, forward-looking programs that will equip them with skills in leadership and quality improvement. One resident actively involved at Cincinnati's medicine-pediatrics team reported that her job interviews went particularly well when she explained her role in a successful performance improvement initiative.
- Chronic Care Model projects can generate positive public recognition. Project leaders at the University of Cincinnati Academic Health Center actively promoted their Chronic Care Model work locally and at national meetings (e.g., an article in the Cincinnati Business Courier focused on the collaborative's approach for teaching new physicians to improve care).
- The Chronic Care Model develops leadership in health care change. Administrators at the University of Cincinnati Academic Health Center went out of their way to support Chronic Care Model work in part because they wanted to help a group of passionate residents and their faculty succeed. Presentations from residents and junior faculty to the senior leadership group helped generate this collective sense of enthusiasm.
Creating the Business Case—Vanderbilt University Medical Center
The Vanderbilt University Medical Center team also determined that specific data outcomes of their participation in the collaborative contributed to making a business case.
Several new resident recruits to Vanderbilt's medicine-pediatric residency program specifically mentioned the work of the collaborative as a facet of the program that greatly increased their desire to train at the program.
- Cost Savings. Data from processes can be used to illustrate cost savings to payers and administrators. For example, the foot exam rate improved from 17 percent to 80 percent, thereby reducing amputation risk. These data can also support the argument that departmental results can be replicated system-wide, to whole patient populations, and across institutions.
- Marketing. Hospitals can use improved care data to market services to patients. For example, rates of blood pressure treated to target (systolic blood pressure less than 130 and diastolic blood pressure less than 80), low-density lipoprotein to target (less than 100), and A1c to target (less than 7.0 percent) were all improved in patients at the Vanderbilt University Medical Center.