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Deploying the Chronic Care Model to Implement and Sustain Diabetes Self-management Training ProgramsFrom the University of Pittsburgh Diabetes Institute, University of Pittsburgh Medical Center (Dr Siminerio, Ms Emerson, Dr Ruppert); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh (Ms Piatt, Dr Zgibor); and the Department of Medicine, University of Pittsburgh (Ms Saul, Dr Solano, Dr Stewart). Correspondence to Linda M. Siminerio, RN, PhD, CDE, 601 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213 (simineriol{at}upmc.edu). Purpose The purpose of this project was to evaluate the utility of using the 6 elements of the chronic care model (CCM; health system, community, decision support, self-management support, clinical information systems, and delivery system design) to implement and financially sustain an effective diabetes self-management training (DSMT) program. Methods The University of Pittsburgh Medical Center (UPMC) uses all elements of the CCM. Partnerships were formed between UPMC and western Pennsylvanian community hospitals and practices; the American Diabetes Association DSMT recognition program provided decision support. A clinical data repository and reorganization of primary care practices aided in supporting DSMT. The following process and patient outcomes were measured: number of recognized programs, reimbursement, patient hemoglobin A1C levels, and the proportion of patients who received DSMT in primary care practices versus hospital-based programs. Results Using elements of the CCM, the researchers were able to gain administrative support; expand the number of recognized programs from 3 to 21; cover costs through increased reimbursement; reduce hemoglobin A1C levels (P < .0001), and increase the proportion of patients receiving DSMT through delivery in primary care (26.4% suburban; 19.8% urban) versus hospital-based practices (8.3%; P < .0001). Conclusions The CCM serves as an effective model for implementing and sustaining DSMT programs.
The Diabetes Educator, Vol. 32, No. 2,
253-260 (2006) This article has been cited by other articles:
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