Improving chronic illness care in teaching practices: learnings from the I³ collaborative

Area of Science:

• Healthcare Quality Improvement
• Medical Education Research
• Regional Health Collaboratives

Background:

• Improving residency education quality is crucial but challenging on a large scale.
• The I³ collaborative aimed to assess a regional approach to quality improvement in residency programs.
• Focus areas included enhancing care for diabetes and congestive heart failure (CHF).

Purpose of the Study:

• To evaluate the feasibility of a regional quality improvement collaborative for residencies.
• To significantly improve the quality of care for diabetes and congestive heart failure (CHF).
• To identify success factors for large-scale quality improvement initiatives in academic medical settings.

Main Methods:

• A 3-year Institute for Healthcare Improvement (IHI) breakthrough series collaborative model was employed.
• Ten residencies in North and South Carolina participated, involving 345,000+ patient visits, 252 residents, and 92 faculty.
• The collaborative incorporated additional support tailored for academic environments.

Main Results:

• Modest improvements were observed in the quality of diabetes care.
• Significant improvements were achieved in congestive heart failure (CHF) care, including a 380% reduction in hospitalizations.
• Key success factors included regional foundation funding, a regional recruitment strategy, active collaborative management, consistent data submission, and a blended learning curriculum.

Conclusions:

• A regional strategy is a feasible and effective model for supporting substantial quality improvement in residency programs.
• Investing in residency redesign can lead to a reduction in the overall cost of care.
• The collaborative model, combining in-person meetings and virtual conferences, facilitated sustained engagement and progress.