History

ICIC has worked for more than a decade with national partners toward the goal of bettering the health of chronically ill patients by helping health systems, especially those that serve low-income populations, improve their care through implementation of the Chronic Care Model.


Development of the CCM and ICIC

The Chronic Care Model (CCM) originated from a synthesis of scientific literature undertaken by The MacColl Institute for Healthcare Innovation in the early 1990’s.  During a 9-month project funded by the Robert Wood Johnson Foundation (RWJF), an early version of the Model underwent extensive review by an advisory panel of experts and was then compared with the features of leading chronic illness management programs across the U.S..  Subsequently, the Model was further refined and published in its current form in 1998.  Improving Chronic Illness Care, a national program of RWJF, was launched in 1998 with the Chronic Care Model at its conceptual core. Read a historical perspective on our early days in the new RWJF anthology.


ICIC approached our goal of helping people with chronic illness through a coordinated program of quality improvement (QI), research and dissemination. To test the utility of the Chronic Care Model in quality improvement, ICIC explored which improvement strategy had the best evidence base and showed the most promise, and chose the Breakthrough Series Collaborative as their improvement strategy.


Quality Improvement Collaboratives

The Chronic Care Breakthrough Series Collaboratives (BTS) began in 1999 in partnership with the Institute for Healthcare Improvement.  Using a clearly defined change package based on the CCM, the BTS Collaboratives provided participants with proven tools and information to assist them in making those changes within their system. As the collaborative program took shape, the Health Resources and Services Administration’s Bureau for Primary Health Care launched its ambitious program to reduce quality disparities among the clients of community health centers. ICIC has collaborated with BPHC and IHI on the Health Disparities Collaboratives since its inception in 1998. A recent article provides information about this effort.


A multidisciplinary research team from RAND Corporation and the University of California at Berkeley undertook a four-year study of ICIC’s three earliest Chronic Illness Care Collaboratives.  Overall, the results of the Improving Chronic Illness Care Evaluation (ICICE) were encouraging:  collaboratives succeeded in helping the practice teams to make many changes in the way they cared for patients with chronic illness, and patient outcomes improved as a result.  Read more about ICICE.


While initial chronic care collaboratives recruited practice organizations nationally, ICIC also participated in regional collaboratives sponsored by public health departments, QI organizations, and other local stakeholders in Washington State as well as other local areas.  To foster more regional improvement efforts, ICIC initiated a Regional Collaboratives Sponsorship Grants program to assist local organizations launch regional and municipal initiatives.   The national and regional collaboratives have involved well over 1000 health care systems to date, ranging in size and sophistication from the Mayo Clinic to a single-doctor practice in Washington State.


Targeted Research Program

Beginning in 2001, ICIC’s three-year Targeted Research Grants Program provided support for peer-reviewed, applied research that addressed critical questions about the organization and delivery of chronic illness care within health systems.  Funded projects included evaluations of  intervention such as group visits or care managers, observational studies of effective practices, and  the development of new measures.  See a list of grantees and funded projects.


Dissemination

The Institute of Medicine issued a landmark report in 2001, “Crossing the Quality Chasm: A New Health System for the 21st Century”, outlining six aims for transforming healthcare in America.  With references to the work of ICIC, the recommendations called for U.S. government to make chronic disease care quality improvement an early priority.


The National Committee on Quality Assurance and The Joint Commission developed accreditation and certification programs for chronic disease management based on the CCM. More recently, the CCM serves as a foundation for new models of primary care promulgated by the American Academy of Family Practice and the American College of Physicians.
The World Health Organization approached ICIC to work on an initiative to adapt the model for developing countries.  The major product of this partnership was the WHO global report, “Innovative Care for Chronic Conditions: Building Blocks for Action”, published in 2002.  The report made the case for restructuring or developing primary care systems capable of providing high-quality chronic illness care.  A more recent comparison of international models has been published by the U.K.'s National Health Service, and can be accessed here.


ICIC and RWJF convened three national congresses to help build the field of chronic illness care.  The meetings included presentations by scholars and practitioners highlighting new research on the current state of chronic care practice, as well as interactive breakout sessions ranging in topic from alternative QI strategies and patient perspectives to international chronic care innovations.

 

Looking Ahead

Recent years have seen growing numbers of initiatives across the country adopt the CCM, including statewide efforts in Indiana, North Carolina, California, Vermont Pennsylvania, and New York.   New York Health and Hospitals Corporation, the largest municipal hospital and health care system in the country, kicked off their chronic disease collaboratives in 2004 with 15 clinical improvement teams working on diabetes and heart failure, and has since added teams addressing depression and pediatric asthma. In California, nine public hospital systems came together in 2004-2005 for the Chronic Care Learning Communities Initiative, working to transform care for diabetic patients.  In conjunction with the Association of American Medical Colleges, ICIC’s collaborative work has recently included academic medical centers across the nation.

 

International versions of the Chronic Care Model have been developed and used in countries as diverse as UK, Canada, Denmark, Russia, China, Australia, and New Zealand.  ICIC’s work was featured in the four-part PBS series “Remaking American Medicine…Health Care for the 21st Century”.  This television program premiered in 2006 and featured an array of pioneering individuals and institutions struggling to better health care across the nation.

The Improving Chronic Illness Care program ended in 2011, but the core team remains at the MacColl Center for Health Care Innovation.