An inconvenient truth: a sustainable healthcare system requires chronic disease prevention and management transformation.

Canada's initial success at shortening wait times will not transform our healthcare system unless it is matched with equal success in the prevention and management of chronic diseases. A growing body of evidence highlights the significant gap between recommended care and actual care received for those at risk for or living with chronic illnesses. This quality gap not only results in significant preventable morbidity and mortality but also lengthens wait times for healthcare services and threatens the sustainability of our healthcare system. A national strategy on chronic disease prevention and management (CDPM) that leverages the federal, provincial and territorial (FPT) response to wait times will not only transform chronic illness care but also help to ensure the sustainability of our healthcare system. We begin this paper by highlighting some of the facts behind this inconvenient truth. We then review and provide examples of several best practices in CDPM. We suggest that these best practices provide the foundation for a national CDPM strategy and argue that the FPT mandate for wait times be expanded to encompass CDPM and result in "care guarantees." We conclude with a high-level preliminary analysis of costs and benefits of this strategy to transform CDPM in Canada.

A state-level application of the chronic illness breakthrough series: results from two collaboratives on diabetes in Washington State.

BACKGROUND: Breakthrough Series Collaboratives addressing chronic conditions have been conducted at the national level and in single health care delivery systems but not at the state level. Two state-level collaboratives were conducted: Diabetes Collaborative I (October 1999-November 2000) included 17 clinic teams from across the state, and Diabetes Collaborative II (February 2001-March 2002) included 30 teams and 6 health plans. METHODS: Both collaboratives took place in Washington State, where a diverse group of primary care practices participated, and health insurance plans partnered with the clinic teams. Teams individually tested and implement changes in their systems of care to address all components of the Chronic Care Model. RESULTS: All 47 teams completed the collaboratives, and all but one maintained a registry throughout the 13 months. Most teams demonstrated some amount of improvement on process and outcome measures that addressed blood sugar testing and control, blood pressure control, lipid testing and control, foot exams, dilated eye exams, and self-management goals. CONCLUSION: The benefits of holding collaboratives more locally include increased technical support and increased participation, translating into wider implementation of prevention-focused, patient-centered care.

Case studies from two collaboratives on diabetes in Washington State.

Two individual teams, one from a small, rural clinic and one from a larger urban health system, were able to introduce innovations in care and realize improvement in patient outcomes.