California Chronic Care Learning Communities Initiative (CCLC) Funded by the California HealthCare Foundation

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California Chronic Care Learning Communities
Initiative(CCLC)Funded by the California
HealthCare Foundation
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Building a Shared Vision for Chronic Care
Improvement

• For diabetic patients served by nine public
  hospital clinics, our goal is to
• Improve care processes
• Decrease complications
• Reduce cardiovascular risk

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What do we want to achieve?

• In 9 months, the CCLC aims to achieve
  breakthrough improvement in
• Control of clinical risk factors
• Use data and information systems to support
  pro-active care
• Improve use of self-management support strategies
  by patients and providers

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Where are we starting from?

• The U.S. health care system does a poor job of
  caring for patients with chronic conditions

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Disturbing facts

• Half of patients hospitalized with congestive
  heart failure are readmitted within 90 days.
• 63 with diabetes have HbA1c levels gt 7.0.
• 66 hypertensives have BP out of control.
• Ni et al. Arch Intern Med 1998158231. Saydah
  et al. JAMA 2004291335. JNC 7. JAMA
  20032892560.

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Californians with chronic illnesses
vs.Californians receiving good care(in millions)
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Most chronic care is primary carePercentage of
Office Visits Accordingto Physician Specialty,
By Primary Dx
Source L Green, Analysis of 1996 Natl Amb Med
Care Survey
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Where are we starting from at the nine CCLC
public clinics?

• 43 of pts. w/hypertension
• 24 of pts. obese
• 10 of pts. smoke

• 13,167 diabetic pts.
• Some clinics report gt 20 HbA1c gt9
• 24 of pts. have high cholesterol

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Where are we starting from at the nine CCLC
public clinics?

• Irregular testing/exams
• Ccare mgmt. left to busy PCPs
• Low ability to stratify pts. by risk

• Fragmented care
• Inadequate information systems
• Lack of pt. self-mgmt.

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We know what is possible
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Chronic Care Model
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Ocean Park Health Center, SF Community Health
Network

• Participated in California Quality Improvement
  Collaborative and, in 6 months, achievements
  include
• ?in pts. w/LDL lt100 from 38 to 53
• ?in pts. w/controlled BP from 36 to 53
• ? in foot exams from 12 to 65
• ?in self-mgmt. goal setting from 0 to 40

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Bureau of Primary Health Care Health Disparities
Collaboratives

• 23 community health centers achieved
• ?HbA1c levels by 1

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Other public hospital clinics have achieved
impressive outcomes

• Santa Clara Valley Medical Centers Chronic Care
  Management Program, in 2 years
• ?HbA1c levels by 1
• Edward R. Roybal Comprehensive Health Center, of
  the LA County DHS, in 6 months
• ?avg. LDL from 115 to 101
• Avg. LDL held at 105 after 1 yr.

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Other public hospital clinics have achieved
impressive outcomes

• San Mateo Medical Center
• Diabetes Outpatient Education Program
• ? pts. w/HbA1c gt8 from 52-54 to 18-20

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Challenges

• Financial instability of public hospitals and
  health systems

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The health care safety net is unraveling fast
precisely when more families are falling into
it. San Francisco Chronicle December 29,
2002
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Other challenges to improving chronic care in
public hospitals/health systems

• No reimbursement for non-physician care
• Inadequate information systems
• Chaotic, overstressed primary care clinics
• Multiple patient languages and few interpreters
• Low health literacy
• Difficulty changing job descriptions of clinic
  staff
• Delivery system geared toward acute illness

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Strengths Why changing chronic care in public
hospital systems will make a difference

• Health disparities patient population is 78
  people of color, predominantly low-income
• Training next generation of health care
  professionals
• Comprehensive systems of care potential to
  improve along continuum of care

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Facilitators for improving chronic care in public
hospitals/health systems

• Leadership/champions
• Culture of doing the right thing
• Why do some organizations perform better than
  others? Virtually every study examining this
  question gives two reasons
• Leadership
• Culture
• Good leadership and a quality-oriented culture
  enable organizations to overcome the barriers

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An impressive group of individuals throughout
California have made major strides -- though
limited in the proportion of the safety net
population reached -- in improving chronic care.
These individuals are the founders of a larger
movement for chronic care improvement in
Californias safety net.

• Examining Chronic Care in Californias
  Safety Net
• www.chcf.org

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CCLC(9-12 months time frame)
Participants (9 teams)
Select Topic (develop mission)
Prework
Congress, Guides, Publications etc.
P
Develop Framework Changes
P
P
A
D
A
D
A
D
Expert Meeting
S
S
S
LS 1
LS 2
LS 3
Planning Group
Supports Email Visits Phone Assessments
Monthly Team Reports
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Learning Session I Agenda

• Today Get ideas!
• Tomorrow Plan changes!