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Chronic Care Model As a Framework to Improve Diabetes Care at an Academic Internal Medicine Faculty-Resident Practice

Hariharan, Jaishree MD; Tarima, Sergey PhD; Azam, Laila MBA; Meurer, John MD, MBA

Journal of Ambulatory Care Management: January/March 2014 - Volume 37 - Issue 1 - p 42–50
doi: 10.1097/JAC.0000000000000007
Original Articles

We implemented a quality improvement project for diabetes care in a faculty-resident internal medicine practice, using the Chronic Care Model framework. We created a planned visit clinic, used a stepwise medication algorithm, and self-management support. The intervention was effective for patients with glycohemoglobin A1c levels 10 or above (P = .0075) when compared with usual care after adjusting for all significant predictors. Compliance with foot examinations increased by 72% (P < .0001) and pneumococcal vaccinations by 25% (P = .0115). We believe that the Chronic Care Model can be successfully integrated into faculty-resident practices and provides a model for further exploration into disease management education in academic settings.

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Department of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Hariharan); and Division of Biostatistics (Dr Tarima) and Public and Community Health Program (Ms Azam), Institute for Health and Society (Dr Meurer), Medical College of Wisconsin, Milwaukee.

Correspondence: Laila Azam, MBA, Institute for Health and Society, Medical College of Wisconsin, 8701 Watertown Plank Rd, H2210, Milwaukee, WI 53226 (

The authors thank the entire DITTO team for their dedication to improving patient care. A special thanks to Jim Kwiatt, MD, Irene O'Shaughnessy, MD, Lee Biblo, MD, Margaret Meyer, APNP, and Mary Conti, BSN, RN, for their expertise and valuable assistance with this project. The project evolved from our experience in the first National Academic Chronic Care Collaborative led by the AAMC in conjunction with the Robert Wood Johnson Foundation.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins