Public hospitals and their associated clinics are key providers of care for the state's uninsured and low-income residents and play an important role in the health care "safety net." California's 19 public hospitals deliver care to all who need it, regardless of a person's ability to pay, immigration status, or insurance benefits. While comprising just 6% of all California hospitals, public hospitals provide nearly 45% of all hospital care to the state's uninsured residents. Public hospitals and their associated clinics provide 11 million outpatient visits per year.
The patient population includes some 250,000 patients with diagnosed diabetes and an estimated 85,000 who remain undiagnosed. National studies show that patients with diabetes and others with chronic disease generally receive recommended care only about half of the time, and even less often when patients are uninsured or underinsured. Better care could mean reduced disability, cardiovascular disease, and premature death, but requires a more planned and systematic approach to diabetes across safety-net hospitals and clinics.
To spur the adoption of quality improvement methods and the use of electronic data by public hospital systems, CHCF allocated up to $1.2 million for a two-year project, titled Spreading Effective and Efficient Diabetes Care in California's Public Hospital Systems (SEED). The project began in January 2007 and continued through December 2008.
The effort included learning sessions for clinic teams, information technology challenge grants to fund projects that increase disease registry functionality and integration, on-site technical assistance from outside experts, and reporting on common quality measures across participating hospital systems.
Teams from 10 public hospitals participated in the improvement efforts over the two years, and all reported progress and activities each month to the California Health Care Safety Net Institute (SNI), the research and educational affiliate of public hospital systems in California. Overall, 38 teams tracked more than 6,300 patients with diabetes in automated chronic disease registries.
By advancing the use of standardized clinical measures and data reporting methods, and by accelerating the adoption of electronic chronic disease registry systems and quality improvement processes, the project was able to show improvements in the percentage of patients with diabetes receiving recommended tests and procedures as well as the percentage of patients with documented self-management goals. The project also demonstrated modest improvements in both blood sugar and blood pressure control across the teams.
This effort follows from the California Chronic Care Learning Communities Initiative, which was launched in July 2004 with a CHCF grant to develop learning communities to create and sustain chronic care improvements within California's public hospital system clinics. Key partners on that project included Kaiser Permanente; the MacColl Institute for Healthcare Innovation at Group Health Cooperative in Seattle; Tom Bodenheimer, MD, at San Francisco General Hospital; and the California Health Care Safety Net Institute, the education and research affiliate of the California Association of Public Hospitals and Health Systems.