Virginia Joint Quality Improvement Initiative w/ Community Health Centers

Submission Date: December 2013

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Virginia

States/Territories Involved: Virginia

Domain Addressed:

Health Systems Strategies

Public Health Issue:

• Delivering high-quality care for diabetes can improve health outcomes and potentially lower health care costs and reduce disparities.
• Implementing the Planned Care Model (also called the Chronic Care Model) can improve the quality of clinical patient care and assure the use of proven strategies for preventing and controlling diabetes and its complications.

Project Objectives:

This project sought to improve quality of care for people with diabetes.

Program Action:

• The Virginia DPCP provided training and technical assistance on implementation of the Planned Care Model (PCM) to improve quality of care for tobacco users and people with diabetes and/or cardiovascular disease who were patients in Virginia’s community health centers (CHCs). To coordinate quality improvement efforts across state programs the initiative was implemented through a joint contract between the Diabetes Prevention and Control Program (DPCP), Heart Disease and Stroke Prevention Program (HDSPP), and Tobacco Use Control Program(TUCP), the Community Care Network of Virginia, and the Virginia Community Health Care Association.
• The DPCP collected baseline data for A1C, blood pressure and cholesterol control and applied a modified version of the Assessment of Chronic Illness Care tool titled Assessment of Chronic Disease Care to assess implementation of the PCM.

Data/Other Information Collected:

The Community Care Network of Virginia(CCNV) to develop a Smart Form to enhance electronic medical record (EMR) systems used by participating CHCs. this allowed them to collect common data elements.

The DPCP collected baseline data on A1C, blood pressure, & cholesterol.
They used a modified version of the Assessment of Chronic
Illness Care (ACIC) tool titled Assessment of Chronic Disease Care (ACDC) to assess implementation of the PCM. Additionally, the DPCP conducted needs assessments of CHC self-management programs and used this information to determine training needs.

Impact/Accomplishments:

• The number of sites using the Planned Care Model increased from 48 to 70 and the number of participating CHC providers using the PCM increased from 93 to 153.
• Improvements in health outcomes for patients at CHCs during the 3 years of the project included:

• Increase from 47% to 50%* in the percentage of patients with A1C control of < 7% (a recommended goal for most patients with diabetes)
• Increase from 43% to 46%* in the percentage of patients with LDL control of <100 mg/dl (recommended goal level)
• Increase from 54% to 56%* in the percentage of patients with diabetes achieving LDL control (recommended goal level)
• Increase from 30% to 33%* in the percentage of patients with blood pressure control of <130/80 mmHg (recommended goal level)

^{*The Virginia DPCP was unable to link its intervention strategies to changes in reported health outcomes for CHCs, as the center identities were blinded for the first 3 years of the project. The health outcome changes may or may not have been directly influenced by this quality improvement initiative.}

Challenges/Lessons Learned:

Major challenges faced in Virginia’s Joint Quality Improvement Initiative:
– Competing requirements placed on CHCs by funders related to patient care and case-load management reduced time for staff training and involvement in quality improvement efforts.
– CHCs took up to one year to install and implement EMR systems and to meet the requirement that data be reported for a year before it could be aggregated.
– Confidentiality concerns made providers reluctant to provide un-blinded site-level data, making it challenging to effectively link intervention strategies to data outcomes.

Lessons learned about successful implementation of this type of project:
– Collaborate across public health programs to share resources and coordinate data collection
– Start with existing structures, like EMR data systems, and build on them to enhance care and make the program sustainable. Building on recent PCMH initiatives for diabetes was a way to motivate CHCs to enhance care for patients.
– Take small steps – this project started with a small, stable group of CHCs to

Program Areas:

Diabetes, Heart Disease and Stroke, Public Health Practice, Tobacco

State Contact Information:

VA
Kathy Rocco
Virginia Department of Health
804-864-7756
kathy.rocco@vdh.virginia.gov

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