(5) using decision support (for patients as well as clinicians) to promote evidence-based care; and (6) creating overarching organizational mechanisms to promote safe, high-quality care (ICIC, 2007). These elements were developed from the findings of a review of the published literature on promising strategies for management of chronic illness. They were refined as a result of input from a large panel of national experts, and subsequently tested nationally across various health care settings through The Robert Wood Johnson Foundation’s Improving Chronic Illness Care program.
Components of the Chronic Care Model have been associated with improved health outcomes in a number of studies (Bodenheimer et al., 2002). In conjunction with the Robert Wood Johnson program, the American Association of Medical Colleges launched an Academic Chronic Care Collaborative (ACCC) to improve care of persons with chronic conditions who receive their care in academic health systems and to ensure that clinical education occurs in an exemplary environment. Teams from 22 academic settings extensively redesigned their care strategies using the Chronic Care Model for persons with diabetes, asthma, and chronic obstructive pulmonary disease and achieved improvements in patient care and outcomes (AAMC, 2006). A RAND Corporation evaluation of the implementation of the Chronic Care Model in four quality improvement collaboratives sponsored by the Institute for Healthcare Improvement also found that implementation of the model for patients with diabetes, congestive heart failure, and asthma improved health care, as well as some dimensions of patients’ illness self-management and health.20 RAND’s before-and-after study included 2,032 intervention patients and 1,837 control patients at 30 participating organizations. Improvements were seen in measures of technical quality of care, such as blood glucose control and use of appropriate heart disease medications. Improved patient outcomes included reductions in emergency room visits and hospital admissions for those with congestive heart failure, improvements in health-related quality of life for patients with asthma, and reductions in risk factors for heart disease (blood pressure, cholesterol, blood glucose levels) for individuals with diabetes.21
Clinical Practice Guidelines for Distress Management
The National Comprehensive Cancer Network (NCCN), an alliance of 21 leading cancer centers in the United States, offers a number of resources for improving health care provided to individuals with cancer (NCCN, 2007b). These resources include clinical practice guidelines, one set of
20Although improvements were not detected in all outcomes.
21Unpublished data from Emmett B. Keeler, PhD, RAND Corporation, February 20, 2007.