Crossing the Quality Chasm for Diabetes Care: The Power of One Physician, His Team, and Systems Thinking

Objective: To demonstrate that one physician can dramatically improve care of diabetes patients by tak-ing a systems approach and getting support from leaders and other team members Material and Methods: Pre-/postcomparison of quality measures for the diabetes patients of one primary care physician, compared with those of his entire large multi-specialty medical group. Working with a mentor and with clinic and medical group leaders, he established a clear goal, focused on a re-peatable and important performance measure, and used repeated rapid cycle trials to make systems changes in care, with extensive task delegation to team members and emphasis on repeated testing and treatment intensification. The composite outcome measure requires that each diabetes patient meet all 5 of the following: LDL<100, HbA1C <7, systolic blood pressure<130, regular aspirin use, and tobac-co-free status. Results: Over a 24-month period, quarterly measures for this physician’s patients rose from 5.7 % to 42.9%, while the 7000 diabetes patients of the entire medical group only increased from 4.2 % to 12.1%. The change for those patients who stayed under his care for the entire period was even more dramat-ic—from 2.3 % to 46.5 % (P <.0001). The largest improvements were for smoking documentation, aspirin use, and LDL control, with little change in HbA1C levels