Improving chronic illness care in teaching practices: learnings from the I³ collaborative

Abstract

Background: Improving the quality of care in residencies is critical for the profession and for our discipline, but how to do this on a large scale is unclear. The purpose of the I³ collaborative was to assess the feasibility of a regional quality improvement collaborative limited to residencies and to improve significantly dramatically the quality of care for diabetes and congestive heart failure.

Methods: Ten residencies in North and South Carolina with more than 345,000 patient visits/year, 252 residents and 92 faculty participated in an Institute for Healthcare Improvement breakthrough series type collaborative, enriched with additional support for academic settings, over 3 years.

Results: We improved measured quality of care for diabetes modestly and congestive heart failure (CHF) significantly/substantially, including a 380% reduction of hospitalizations for CHF. Success factors include funding from regional foundations, the use of regional approach for recruitment of residencies and active management of the collaborative, regular data submission, and a blended curriculum with a combination of biannual face to face meetings and monthly telephone conferences.

Conclusions: A regional strategy is feasible and can strongly support quality improvement; investment in residency redesign can reduce total cost of care.