AR Chronic Illness Collaborative (ACIC)

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Submission Date: December 2012

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Arkansas

States/Territories Involved: Arkansas

Domain Addressed:

Health Systems Strategies

Public Health Issue:

  • Many of the states clinic practices need to improve their system of care in order to align their medical practices with evidence-based clinical guidelines to manage chronic disease.

Project Objectives:

To provide a forum for clinic health care teams to improve delivery of patient care by: tracking and reporting key measures; sharing ideas and knowledge, learning and applying new methodologies for organizational change; implementing the Planned Care Model; laying the ground work for clinics to reach Meaningful Use and Patient Center Medical Home designation.

The collaborative targeted primary care practices affiliated with a hospital, health system, or practice network; private primary care practices (family or internal medicine practice); health care network clinics, community health clinics, health education centers.

Program Action:

  • Since 2003 the ACIC has provided quality care improvement training to state health clinics to improve health outcomes for chronic diseases. Using proven practices, the ACIC partners with health care professionals in order to find ways to improve the management of chronic disease.
  • The Collaborative supports the Essential Public Health Services Framework and maximizes the length and quality of life for patients with chronic disease, satisfies patients and caregivers needs, and maintains and decreases the cost of care.
  • Clinics are chosen through a request for application process and may receive funding of up to $9500 over a 13-month period.
  • Partners included: AR Foundation for Medical Care (QIO); Community Health Centers of AR; AR Geriatric Education Center; UAMS Department of Family & Preventive Health, CME Division; AR Department of Health’s Heart Disease and Stroke Prevention Section, Diabetes Prevention and Control Section and Tobacco Cessation and Prevention Program.

Data/Other Information Collected:

Required measures and percent goals for the collaborative teams are:

Cardiovascular

  • Hypertension Patients with BP <140/90 >50%
  • Two BP’s in Last Year >90%
  • Documented self- management goal >70%
  • Fasting Lipid Profile Documented >80%
  • Patients with LDL <100 >60%
  • CAD on ASA or anti-thrombotic Agent >90%
  • Tobacco use status-Ask, Advise, Refer >80%
  • 10% of patients 65+ years of age
  • Registry size of 100 or more

Diabetes

  • Average HbA1c <7.0%
  • Patients with 2 HbA1c’s in last year (3 months apart) >90%
  • Documentation of self-management goal setting >70%
  • Patients with diet counseling by CDE in past year >80%
  • Patients with documented eye exam in past year >70%
  • Patients with documented foot exam in past year >90%
  • Patients with BMI 25+ losing 10 lbs. in past year >30%
  • Patients with BP <130/80 >40%
  • Patients with LDL <100 >70%
  • Tobacco use status-Ask, Advise, Refer >80%
  • 10% of patients 65+ years of age
  • Registry size of 100 or more

Impact/Accomplishments:

  • The ACIC has trained more than 100 clinics focusing on two diseases- diabetes and cardiovascular disease.
  • During the 10th Collaborative, the cardiovascular clinics reported:
    • 51.5% of hypertensive patients were controlled
    • 67.9% of patients with LDL cholesterol were treated to goal
    • 58.8% of patients with coronary artery disease were on aspirin or anti-thrombotic agents
    • 31.6% of patients were asked, advised and referred for tobacco cessation
  • The CVH clinics in this collaborative have the potential reach of 17,821 patients and the diabetes clinics have a potential reach of 9,000+ for a total of 26,821 patients.

Challenges/Lessons Learned:

  • Lack of IT staff in clinics
  • Cumbersome process for seeking IT support from EMR contractor to create/correct data
  • Staff turnovers
  • Physicians reluctant to change the way they practice medicine
  • Time away from clinic practice to attend learning sessions

Next Steps:

Working with ACIC consultant to develop plans to train clinics to meet Meaningful Use and Patient Medical Home certification Exploring possibilities of bringing the training to clinics in rural areas with less than 5 staff to overcome the need to be out of the office for two days at a time to attend three learning sessions and a congress over a 13-month period.

Program Areas:

Healthy Communities (general)

State Contact Information:

AR
Patricia McManus, BSN, RN
Arkansas Department of Health
501-661-2075

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