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Our funding for updating this website ended in 2011, but the resources we developed are still helping clinical practices from around the world to transform the care they provide to better serve patients with chronic illness. Please visit our home page to learn more—or check out our more recent tools and resources at:



ICIC's compendium of tools was created for the specific purpose of preparing for and conducting a collaborative health care improvement effort.  The tools included in this section are from ICIC's work with The Breakthrough Series Collaboratives and academic medical centers throughout the United States.

A Breakthrough Series Collaborative (BTS) is a short-term (6- to 15-month) learning system that brings together a large number of teams from hospitals or clinics to seek improvement in a focused topic area.  Each team typically sends several members to attend Learning Sessions (three face-to-face meetings over the course of the Collaborative), with additional members working on improvements within the local organization.

While the BTS Collaboratives have helped foster collaborative learning within a variety of organizations, relatively few academic clinical practice settings have implemented the CCM.  There are even fewer settings doing this work that incorporate students and resident trainees as integral members of the clinical teams.  The academic collaboratives sponsored by ICIC and The Association of American Medical Colleges (AAMC) build on the premise that academic settings are committed to implementation of innovation that is evidence-based and can be shown to benefit patients. It is doubly important in academic settings because there is the opportunity for such improvements to be incorporated into the care of future patients through the education of tomorrow’s health professionals.

Health care organizations not participating in a regional collaborative will find presentations, educational videos and interactive products designed to effect system change without connection to a formal collaborative structure.  Except as noted, materials can be freely adapted to fit particular organizational needs.  Please note that all tools are offered for guidance purposes only.

Key results of ICIC's work with the AAMC collaboratives include:

  • Teams that focused on diabetes showed improvements in process measures that correlate with quality diabetes care, such as giving patients regular eye and foot exams. Improvement in clinical patient outcomes, such as lowered LDL (bad cholesterol) or lowered hemoglobin A1C (blood sugar count), was mixed.
  • Most of the teams were able to make changes to their educational programs in chronic illness care that also aligned with teaching the competencies required by the Accreditation Council for Graduate Medical Education (ACGME).

Read more about Coaching Academic Medical Centers in the Chronic Care Model