Presentation (Times are in PDT)

A Framework for Multi-Specialty Collaboration to Improve Chronic Care Quality Performance

3:00 PM–3:15 PM May 20, 2020 (Conference Time: US - Pacific)

3:00 PM–3:15 PM May 20, 2020


Abstract: Methods:
To achieve the 16% decrease in the number of Diabetes patients with an A1c≥9, Christiana Care implemented the following methods: defined baseline metrics and scope, aligned incentives across specialties, developed an interprofessional team governance structure, enacted a multi-phased performance improvement curriculum and collaborated with technology vendor to deploy a chronic condition registry and optimize workflow needs.

Christiana Care improved the accuracy of attribution in the Diabetes registry by 11%, reduced the percent of patients with an A1c above 9 overdue for labs by >50% and saw an overall 16% decrease in the number of Diabetes patients with an A1c≥9.

Discussion of Results
The results were highly dependent on setting a clear goal to achieve, identifying a committee and governance structure, aligning incentives across multi-specialty teams, tailoring technology to complement workflow and setting realistic expectations for the scope and goals.

To overcome health care silos that impede quality performance and efficiency, organizations need to implement a comprehensive model that includes: interdisciplinary care teams, accessibility to a variety of data sources, incentive alignment and a data-driven framework. Through thoughtful implementation of such a model, Christiana Care was able to achieve a 16% decrease in the number of Diabetes patients with an A1c>9.

Describe the new knowledge and additional skills the participant will gain after attending your presentation.: Attendees will be exposed to a structured framework and best practices of how to implement a data-driven, multi-specialty performance improvement curriculum to improve chronic condition quality metrics. The framework consists of: standardizing care to improve quality metrics in the primary care setting, validating and deploying a registry tool for population-based chronic condition management and building a model for primary-specialty integration through concierge partnerships.


Marina Zeltser (Presenter)
Christiana Care

Sarah Schenck, Christiana Care
Amy Wachter, Christiana Care
Kim Tran, Christiana Care
Ariel Adams, Christiana Care
Barbara Stout, Christiana Care