Deploying the chronic care model to implement and sustain diabetes self-management training programs

Area of Science:

• Healthcare Management
• Chronic Disease Management
• Diabetes Care

Background:

• Diabetes self-management training (DSMT) programs are crucial for improving patient outcomes.
• Implementing and sustaining effective DSMT programs presents significant financial and logistical challenges.
• The Chronic Care Model (CCM) offers a framework for improving chronic illness care.

Purpose of the Study:

• To evaluate the utility of the 6 elements of the CCM for implementing and financially sustaining DSMT programs.
• To assess the impact of CCM-based DSMT implementation on program recognition, financial reimbursement, and patient outcomes.
• To determine the optimal delivery setting for DSMT within a CCM framework.

Main Methods:

• The University of Pittsburgh Medical Center (UPMC) utilized all 6 elements of the CCM.
• Partnerships were established with community hospitals and practices, with the American Diabetes Association providing decision support.
• Process and patient outcomes, including program recognition, reimbursement, hemoglobin A1C levels, and DSMT delivery location, were measured.

Main Results:

• The CCM implementation led to increased administrative support and expanded recognized DSMT programs from 3 to 21.
• Program costs were covered through enhanced reimbursement, and patient hemoglobin A1C levels significantly decreased (P < .0001).
• DSMT delivery increasingly occurred in primary care settings (26.4% suburban, 19.8% urban) compared to hospital-based practices (8.3%; P < .0001).

Conclusions:

• The CCM is an effective model for the successful implementation and financial sustainability of DSMT programs.
• Integrating DSMT into primary care settings, guided by the CCM, improves patient outcomes and program reach.
• The CCM framework facilitates the expansion and long-term viability of diabetes self-management support.