Toolkit for Implementing the Chronic Care Model in an Academic Environment
As one of its improvement projects, the Vanderbilt University Medical Center developed a process to reduce low-density lipoprotein (LDL) rates to meet the Adult Treatment Panel guideline of less than 100 mg/dL. The center produced a treatment protocol that improved the way the team monitors and determines proper medications for patients in order to optimize LDL control.
Vanderbilt University Medical Center
For one of its improvement projects, the Vanderbilt University Medical Center developed a process to reduce low-density lipoprotein (LDL) rates to meet the Adult Treatment Panel (ATP III) guideline of less than 100 mg/dL.
To accomplish this goal, the team produced a treatment protocol (PowerPoint® File, 470 KB; Text Version) by medication type rather than specific medication. This approach improved the way the team monitors and determines proper medications for patients in order to optimize LDL control.
Incorporating a collaborative team approach that included the patient, physician, nurse, clinical assistant, data manager, and pharmacist, the project used the ATP III guidelines for statin use as the protocol.
After identifying a group of 120 diabetic patients with an average LDL rate of 126.7, the team developed the following process:
- The pharmacist reviews the patient's medical record, determines a therapy recommendation, and informs the primary care provider of the plan.
- After the provider approves or amends the plan, the team advises the patient (by phone or letter) of the recommended plan.
- The team prepares a lab sheet for the patient and sends him or her educational materials.
- After the pharmacist calls in the new prescription, the team follows up with the patient and updates the patient's medical record.
The team monitored progress for 8 months and saw a decrease in the baseline LDL rate (126.7) to 110 mg/dL, with 40 of the original 120 patients at the 100 mg/dL goal.
Because there is no certified diabetes educator on this team, the service cannot be billed. However, the team estimates that it only cost about $4 to 6 per patient for this augmentation service, not counting overhead, supplies, etc.
The team identified the following success factors in their approach:
- The medical staff agreed to the goals.
- Other clinics helped coordinate the plan once they were contacted.
- The pharmacist completed the first two steps in the electronic medical record.
- The staff used phone calls and letters to reach the patient, and the letter was added to the patient's chart.
- Used two medicines.
The Vanderbilt University Medical Center team believes the results will attract a payer willing to fund the continuation of the process, and the faculty is very willing to support it. The plan included simple changes that cost patients about an additional $45 a month on average.