Deploying the Chronic Care Model to Implement and Sustain Diabetes Self-management Training Programs

• Published in: The Diabetes educator Vol. 32; no. 2; pp. 253 - 260
• Main Authors: Siminerio, Linda M, Piatt, Gretchen A, Emerson, Sharlene, Ruppert, Kristine, Saul, Melissa, Solano, Francis, Stewart, Andrew, Zgibor, Janice C
• Format: Journal Article
• Language: English
• Published: United States Sage Publications, Inc 01-03-2006
• Subjects: Care and treatment; Case studies; Chronic Disease; Chronic diseases; Delivery of Health Care; Diabetes Mellitus - psychology; Diabetes Mellitus - rehabilitation; Diabetics; Humans; Models, Theoretical; Nursing; Patient Education as Topic - methods; Self Care; Self-care, Health; Social Support; United States
• ISSN: 0145-7217; 1554-6063
• DOI: 10.1177/0145721706287156

Purpose The purpose of this project was to evaluate the utility of using the 6elements of the chronic care model (CCM; health system, community, decisionsupport, self-management support, clinical information systems, and deliverysystem design) to implement and financially sustain an effective diabetesself-management training (DSMT) program. Methods The University of Pittsburgh Medical Center (UPMC) uses all elements of theCCM. Partnerships were formed between UPMC and western Pennsylvanian communityhospitals and practices; the American Diabetes Association DSMT recognitionprogram provided decision support. A clinical data repository andreorganization of primary care practices aided in supporting DSMT. Thefollowing process and patient outcomes were measured: number of recognizedprograms, reimbursement, patient hemoglobin A1C levels, and the proportion ofpatients who received DSMT in primary care practices versus hospital-basedprograms. Results Using elements of the CCM, the researchers were able to gain administrativesupport; expand the number of recognized programs from 3 to 21; cover coststhrough increased reimbursement; reduce hemoglobin A1C levels (P <.0001), and increase the proportion of patients receiving DSMT throughdelivery in primary care (26.4% suburban; 19.8% urban) versus hospital-basedpractices (8.3%; P < .0001). Conclusions The CCM serves as an effective model for implementing and sustaining DSMTprograms.