UAB Synopsis, Vol. 25, No. 20, September 11, 2006

Chronic diseases such as diabetes, arthritis, cardiovascular diseases, and cancer affect more than 125 million Americans and kill 2 million Americans each year, according to the National Center for Chronic Disease Prevention and Health Promotion. Today, medical advances allow people to live for years with complicated and often advanced chronic diseases, resulting in the need to navigate a health care system designed primarily for acute care.

To improve care for the chronically ill at academic health systems and enhance clinical education regarding chronic illness, the Association of American Medical Colleges, in partnership with the Robert Wood Johnson Foundation, has launched the Academic Chronic Care Collaborative (ACCC).

UAB, in conjunction with the Birmingham Veterans Affairs Medical Center, was selected to participate in the nationwide program, along with 21 other medical schools and teaching hospitals.

“Data confirm that we have a burgeoning aging population beset by chronic health problems and a training system that has not remodeled to address the shifting demographics,” says Christine S. Ritchie, MD, MSPH, director of the Center for Palliative Care, and project coordinator of UAB’s ACCC initiative.

“Medical education is organized around diagnosis, which determines the type of treatment patients receive, with less attention given to maintaining and enhancing function, coordinating services, and sustaining or improving quality of life,” she says. “Because our health care system is designed around multiple specialties and settings of acute care, patients often must seek multiple providers and service settings, which can be confusing and difficult to manage.

“Patients with chronic conditions usually struggle with the need for behavioral changes such as diet and exercise patterns, persistent fluctuating symptoms that require chronic treatment, health-altering social and work environments, emotional distress and depression, and the need to interpret symptoms and request interventions,” Dr. Ritchie says.

The ACCC initiative is guided by the Chronic Care Model, a model that emphasizes a partnership between a prepared, proactive medical team and informed, activated patients to achieve optimal results when managing chronic conditions. The model stresses improving patient care by studying clinical data to improve outcomes, enhancing clinical information systems, collaborating within a multidisciplinary team, comparing results with other academic health centers, and clinical trials for improving practice results and clinical decision making.

As an ACCC participant, UAB is using the Chronic Care Model first for patients with advanced chronic obstructive pulmonary disease (COPD). Using scientifically derived guidelines, the UAB/Birmingham VA ACCC Program developed educational materials for patients, trainees, and faculty to insure COPD patients improve their quality of life through self-management support, aggressive assessment and treatment of dyspnea, preventive measures, and advance care planning.

At UAB, program participants are tracking patient outcomes and working with residents at clinics at UAB and the VA to come closer to achieving proposed benchmarks. Working with the UAB Health System and the Birmingham VA, they intend to expand the model to other sites of care and to other chronic conditions.

Other participating institutions are adressing a number of chronic conditions including diabetes, asthma, congestive heart failure, and posttraumatic stress disorder.