Implementing the Chronic Care Model for Improvements in Diabetes Practice and Outcomes in Primary Care: The University of Pittsburgh Medical Center Experience

Abstract

Diabetes care is becoming a priority for health systems as costs and health outcomes are being closely scrutinized. Because traditional health care systems are designed to provide symptom-driven responses to acute illnesses, they are poorly configured to meet the needs of the chronically ill.1 Models that are focused on both outcomes and prevention have been developed and proposed as viable alternatives to our current care systems to address these problems.1–3 To date, few organizations have made the comprehensive systems changes associated with demonstrably better patient and system outcomes.4 Successful chronic disease management has been a difficult challenge within the United States because of numerous factors, which include lack of information technology in outpatient settings; multiple sources of nonintegrated information; limited access to and use of diabetes specialists including education services; and time constraints. A Chronic Care Model (CCM) has been developed that is organized around elements that have been shown to improve outcomes. The elements of the CCM include decision support, clinical information systems, self-management education, and delivery system design.1 The University of Pittsburgh Medical Center (UPMC) has taken steps to implement the CCM into its network to improve diabetes care processes and outcomes in its practice settings. Of the 17 million people with diabetes nationwide, 1.1 million are Pennsylvanians. It is estimated that 660,000 people in Pennsylvania have been diagnosed with diabetes (7.0% of the population).5 UPMC provides services for the vast majority of people with diabetes throughout western Pennsylvania. UPMC is an integrated health system including 19 hospitals; a diversified services division with information technology, laboratory, and community diagnostic services; a physician division, which includes 220 primary care providers (PCPs) and 1,200 academic physicians; and an insurance division. UPMC provides services for ∼80,000 people with diabetes. With its expansive network of …