Overview of module 5

This module has been designed to guide you through the process of implementing good self-management support in your practice. The recommended process is:

• organise a self-management support improvement team
• select an assessment tool(s)
• complete the survey and analyse the results
• identify areas of weakness in self-management support
• identify an area(s) for improvement
• use the PDCA cycle to plan, trial and measure the initiative(s)
• make changes to your practice
• periodically re-survey and begin the improvement cycle again.

Your reflections on the process can be recorded in module 5.7.

 Quality improvement in self-management support

The Chronic Care Model was introduced in module 2. Evidence-based research supports this framework as a guide to quality improvements in health care.^(1,2,3) One of the six key areas of a health care system that encourages high-quality chronic disease care is self-management support.⁽⁴⁾

For the purpose of this module, self-management support will be considered an isolated program or project. It should be remembered that self-management support is one of a number of components of the multidisciplinary Chronic Care Model. For a complete overhaul of chronic care provision, all elements of the Chronic Care Model should be considered.

Large scale improvements are dependent on external factors; the community, the health systems and the institution itself. It is suggested that a visionary clinical leader and solid financial backing are required to successfully integrate all components of the model.⁽³⁾ However, improvements can be achieved through taking small steps. An assessment of current practice will highlight strengths and weaknesses in the delivery of self-management support. Interventions can then be implemented to reduce the gaps between current practice and ideal practice. Not all initiatives require large expenditure and major changes.

Taking the first steps is the key to improving self-management support. A good starting challenge is to provide a case to finance and administrative staff of the benefits and needs for a qualitative improvement initiative. The benefits include:

• improving patient’s health
• enhancing patient satisfaction and loyalty
• improving staff satisfaction and retention.⁽⁵⁾

Assessment tools

There are a number of user-friendly assessment tests in the public domain that help to define the elements of self-management support and to set targets and benchmarks for quality improvement. The recommended assessment tools for this project are the:

• Assessment of Clinical Care Resources and Supports for Chronic Disease Self Management (CCRS). (This is an adaptation of the Assessment of Primary Care Resources and Supports for Chronic Disease Self Management (PCRS)).

• Patient Assessment of Chronic Illness Care (PACIC).

Results from using these assessment tools can help individual clinicians or teams identify areas where current practice does not reflect good self-management support, and use basic quality improvement processes to plan and implement changes to improve practice in this regard. It is proposed that combining information from the CCRS, which is based on clinicians reflecting on their practice, with information from the PACIC, which assesses the patient experience of care, will provide teams with a balance of feedback regarding current self-management support practices.

The Assessment of Chronic Illness Care (ACIC) has a growing reputation as a reliable and valid instrument to assess the quality of chronic care provision. It is closely linked with the key elements of the Chronic Care Model⁽⁶⁾ and may be a more appropriate assessment tool for health practices wishing to improve on chronic care provision in its entirety (self-management support, delivery system design, decision support and clinical information systems). A link is provided for further research on this tool and for a copy of the ACIC survey. http://www.improvingchroniccare.org/index.php?p=ACIC_Survey&s=35

References

1. Wagner EH, Austin BT, Von Korff M. Improving outcomes in chronic illness. Managed Care Quarterly 1996;4(2):12–25.
2. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. Journal of the American Medical Association 2002;288(14):1775–9.
3. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness The Chronic Care Model, Part 2. Journal of the American Medical Association 2002;288(15):1909–14.
4. Improving Chronic Illness Care website http://www.improvingchroniccare.org
5. MacColl Institute for Healthcare Innovation. Integrating chronic care and business strategies in the safety net. Prepared for Agency for Healthcare Research & Quality, US Department of Health and Human Services, 2008. Available from http://www.improvingchroniccare.org/downloads/ICIC_Toolkit_Full_FINAL.pdf
6. Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of Chronic Illness Care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002;37(3): 791–820.