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Care Delivery

California Improvement Network

January 2008

Despite the availability of information about best practices in chronic disease care, many patients still do not receive the care and support they need to most effectively manage their conditions. The California HealthCare Foundation (CHCF) seeks to measurably improve chronic disease care in California by expanding the number of primary care providers (clinicians and systems) who use clinical data to drive improvements in care.

The California Improvement Network (CIN) was first established in 2005 as a social network to share ideas about improving care delivery. Over the next two years, it sponsored training for more than 400 clinicians in specific quality improvement skills and has evolved into an organization of partners (see list below) who care for some 20 million Californians, of which an estimated 4 million have chronic conditions. The CIN partners work with clinicians from a broad range of outpatient settings in California. They include statewide organizations as well as regional groups, and represent private commercial medical groups, public and private community clinics, public hospitals, a county health department, and a Medi-Cal managed care health plan.

Chronic Disease Care: Better Ideas in Action Conference on November 6-7, 2008 San Francisco, California CHCF and the California Improvement Network are sponsoring a unique forum for exchanging practical ideas to improve chronic disease care. The conference is open to clinical staff, administrators, payers, and purchasers -- anyone eager to lead change in chronic disease care. Registration is now open at www.CalChronicCare.org.

CIN partners are committed to measurement, accountability, and active collaboration as they focus on issues including:

• Use of clinical information systems to monitor patient populations with chronic conditions and to track/improve individual patient care;
• Techniques for diffusion of better models of care (for example, electronic decision support tools or improving clinical work flow);
• Team care and engaging patients in their care; and
• Aligning financial incentives to support better chronic disease care.

Today, the CIN is a formal partnership between CHCF and selected improvement programs that introduce and support changes in multiple clinician practices involving large numbers of providers. To qualify, potential partners must have a mission that includes: improving outpatient chronic disease care for a population of patients across the state or in a geographic region; a senior leader accountable to the organization's executive leaders and/or board for improved outpatient care; a specific and documented plan for spreading elements of better chronic illness care across its clinical sites, with staff assigned to help implement the plan.

Partner organizations include:

• California Quality Collaborative (formerly the Breakthroughs in Chronic Care Program). This organization, sponsored by the Pacific Business Group on Health, represents 90 medical groups and practice associations (about 14,000 primary care physicians and thousands of additional health care professionals) throughout California.
• California Academy of Family Physicians. A statewide organization representing about 7,000 physicians.
• California Primary Care Association. A statewide organization of community clinic consortia representing more than 700 community clinic sites.
• Humboldt-Del Norte Independent Practice Association. This organization includes 29 primary care practices and 5 safety-net clinics in two counties and is recognized for its innovative approach to chronic disease care.
• Los Angeles Department of Health Services. A county safety-net provider that includes hospitals, health centers, clinics, and public-private partnerships with 100 organizations.
• Partnership Health Plan. A Medi-Cal managed care plan that covers care at 130 sites in Napa, Solano, Sonoma, and Yolo Counties.
• Safety Net Institute of the California Association of Public Hospitals. This organization represents 16 public hospitals and 64 associated outpatient clinics across the state.

Over the next three years, the CIN intends to expand to include additional partner organizations. Along with participation in workshops, trainings, and conferences to increase effectiveness in spreading better chronic illness care, each CIN partner will receive customized coaching and support from national experts including the Institute for Healthcare Improvement (IHI) and the Improving Chronic Illness Care program at Group Health Cooperative's MacColl Institute. The partners are working together to establish a common set of metrics by which they can track progress.

Better Ideas for Chronic Care: Regional Conferences in 2006-07

Building on the positive response to the 2005 statewide Better Ideas Conference (see next section), CHCF sponsored nine regional conferences to foster working relationships among California clinicians leading improvement efforts across various sectors such as public hospitals, community clinics, commercial medical groups, small private practices, etc. Conferences were held in these counties and groups of counties: Alameda; Calaveras and Tuolumne; Monterey; Los Angeles; Merced; Napa, Solano, and Yolo; San Diego; San Francisco; and San Joaquin.

Chronic Disease Care: Better Ideas for Solving Real World Problems

This networking conference sponsored by CHCF took place in November 2005 and facilitated the exchange of practical ideas to improve chronic disease care and provided opportunities for clinicians to discuss innovative practice methods. Among the ideas shared were ways to improve face-to-face time with patients; successful patient self-management strategies; and practical solutions for a wide range of practice settings. Conference participants heard from leaders in chronic disease care and change management, and joined in sessions to evaluate various clinical information technology tools from their perspectives as potential users. Twice as many participants as expected stayed for an afternoon brainstorming session at the end of the second day.

A conference highlights report is available under Document Downloads below, as well as an audio report about the conference and the California Improvement Network. Conference presentations are available at www.CalChronicCare.org.

Document Downloads

Conference Highlights -- Chronic Disease Care: Better Ideas for Solving Real World Problems (260K)

Better Ideas Conference: Exhibit Guide to Chronic Disease Management Systems (1.888MB)

Chronic Disease Management Systems: Report to Conference Participants (826K)

Related CHCF Pages

It Takes a Region: Creating a Framework to Improve Chronic Disease Care

Multimedia

Chronic Care Audio Report  High Bandwidth

Chronic Care Audio Report  Low Bandwidth

External Links

IHA Compendium of California HealthCare Quality Improvement Projects

Help with Document Downloads and Media Players