Introduction of the chronic care model into an academic rheumatology clinic

Abstract

Background While the chronic care model has been extensively used for the management of patients with diabetes in non-academic, primary care settings, it is not clear whether this model can be used effectively in academic, specialty clinics for other chronic disorders. Methods Through the Academic Chronic Care Collaborative, the chronic care model was introduced to help manage patients with osteoarthritis in an academic rheumatology service with seven prespecified goals. These goals included measurements of Western Ontario MacMaster (WOMAC) osteoarthritis scores, self-efficacy scores and exercise time.Results Five a priori goals were achieved in this study: average WOMAC scores less than 1000 mm as measured on a visual analogue scale, average selfefficacy score of less than 5 mm, average exercise time greater than 90 min, more than 40% of patients exercising at least 60 min per week and a 20% improvement in self-efficacy scores. However, a 20% improvement in WOMAC scores and a 60% completion of documented self-management goals in our patients were not achieved. Our inability to achieve our selfmanagement goal underscores the fact that we have not yet fully implemented the chronic care model into our practice. The inability to detect a 20% improvement in WOMAC scores in the context of having reached our absolute WOMAC goal at baseline suggests a probable ceiling effect for this measure.Conclusions The chronic care model can be effectively introduced into an academic specialty service and can be used effectively in the management of patients with nondiabetic disorders, in this case osteoarthritis.Osteoarthritis is a common chronic medical condition. The number of people in the USA affected with this disorder is expected to increase from 40 million in 1995 (15% of the population) to 59 million in 2020 (18% of the population).1 It is associated with substantial costs to the individual (pain, functional impairment and reduced quality of life) and to society (disability and loss of productivity). Despite its high prevalence and social burden, there are no disease-modifying medications for osteoarthritis. 2There are, fortunately, effective pharmacologic and non-pharmacologic treatments that can help patients with osteoarthritis. Weight reduction and exercise are two of the more important nonpharmacologic treatments that motivated patients can use to help ameliorate their problems.3 There are significant barriers, however, to the use of pharmacologic (risk of complications with the use of non-steroidal anti-inflammatory agents in older persons) and non-pharmacologic treatments (reluctance to exercise a joint affected with osteoarthritis 4 ). The chronic care model may be useful in such a setting. According to this model, optimal care can be achieved when a prepared practice team interacts with an activated patient. 5 There are six key elements to the chronic care model. Selfmanagement support is, for example, one of these elements that can effectively empower patients to overcome obstacles and deal with their he...

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Collaborative Ambulatory Orthopaedic Care in Patients with Hip and Knee Osteoarthritis: A Retrospective Comparative Cohort Study on Health Utilisation and Economic Outcomes

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Evaluation of a collaborative ambulatory orthopedic care program for patients with hip and knee osteoarthritis: a comparative observational cohort study

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