Creating Effective Communication and Coordination

Toolkit for Implementing the Chronic Care Model in an Academic Environment

Intensifying Therapy Using Podcasts

Self-Guided Learning Podcasts

By incorporating algorithms (such as Summa's Planned Visit Algorithm) of care and self-guided learning podcasts (Summa's podcast modules and Podcast Technology Fact Sheet) into the curriculum, the Summa Health System's internal medicine team was able to avoid or overcome clinical inertia.

Developed by the team's clinical expert, this algorithm-driven care method provides residents with evidence-based steps for intensified care in glycemic control, hypertension, and lipid-lowering therapy.

Podcasts accommodate residents' busy schedules with a short and easily accessible way to review specific topics and receive immediate feedback using a Web-based post-test that assesses the residents' learning. This use of Web-based learning has allowed the entire care team to gain an understanding of the clinical approach to take for patients who have not achieved clinical goals for their disease state. This improved "tacit team knowledge" has played a role in better patient outcomes.

Diabetes Management Algorithm

The Christ Hospital team (which joined with the University of Cincinnati Hospital in 1994 to form the Health Alliance) developed an easy-to-use diabetes management algorithm to immediately reduce extremely high HbA1c levels in diabetes patients. The resulting Diabetes Outpatient Intensification Treatment (D.O.I.T.) protocol was created to overcome specific barriers the team identified as thwarting attempts to lower HbA1c levels.

Tools:

Current as of January 2008
Internet Citation: Creating Effective Communication and Coordination: Toolkit for Implementing the Chronic Care Model in an Academic Environment. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/chroniccaremodel/chronic2d.html