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Leadership for Advancing Chronic Care in Challenging Environments

This initiative focuses on improving chronic care in challenging environments. It addresses the prevalence and costs of chronic illnesses, the need for system improvement, and the benefits of the Chronic Care Model. Leadership plays a crucial role in driving change in complex adaptive organizations.

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Leadership for Advancing Chronic Care in Challenging Environments

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  1. Leadership for Advancing Chronic Care in Challenging EnvironmentsCalifornia Chronic Care Learning Communities Initiative Collaboration Kevin Grumbach, MD UCSF and SFGH

  2. Institute of Medicine2001

  3. % of People in US with a Chronic Illness 1 Chronic Illness 45% 57% 43% 2 or more Chronic Illnesses Source: C Hoffman et al, JAMA 1996:276:1473

  4. Chronic Illness:Prevalence and Health Costs Source: C Hoffman et al, JAMA 1996:276:1473

  5. Chronic Illness:Room for Improvement • 27% of hypertensives are adequately treated • Half of discharged CHF patients are readmitted within 90 days • 35% of eligible patients with atrial fibrillation receive warfarin • 74% of diabetics have uncontrolledblood pressures, 71% have elevated lipids, and 54% have hemoglobin a1c levels above 7.0

  6. ROOM For Improvement:Reprise CHN • 30% CHF discharges readmitted within 30 days • 21% diabetics have hemoglobin a1c > 9.5% • 57% of children with persistent asthma not on inhaled steroids

  7. System ProblemNeeding Systems Solution • IOM Redesign Imperatives: • Reengineered care process • Effective use of information technologies • Knowledge and skills management • Development of effective teams • Coordination of care over patient conditions, services, sites of care over time

  8. The Chronic Care Model • Community Resources • Health Care Organization • Delivery System Redesign • Self-management Support • Clinical Information Systems • Decision Support

  9. Does the Chronic Care Model Work? • Impact on quality of care • Impact on costs

  10. Business Case for Chronic Care Model • Depends on payor mix and payment incentives • Uninsured • Global capitation • MediCal • Medicare

  11. Other Benefits to the Organization • Treating the chronic ills of safety net culture • Activated staff • Culture of improvement and problem solving • Change is possible

  12. How can change be created in complex adaptive organizations?

  13. Special Challenges forthe Safety Net

  14. Functional Health Literacy,Diabetic Patients at SFGH Source: D Schillinger et al, JAMA 2002;288:475

  15. Assets of the Safety Net • $ Incentives not always completely misaligned • Systems and organization • Talent and commitment

  16. The Role of Leadership

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