The study, published online Sept. 9, reviewed the early progress from 2008 to 2010 of the Chronic Care Sustainability Initiative (CSI-RI), an effort designed to improve the quality of primary care for Rhode Islanders, and reduce the overall cost of health care in that state and improve population health.
Since Dec. 2011, a five-member team from Commonwealth Medicine’s Office of Program Development and Enterprise Project Management, along with staff from the Center for Health Policy and Research (CHPR), has been providing day-to-day project direction and management for the initiative. Led by Debra Hurwitz, MBA, BSN, of the Office of Program Development and David Keller, MD, formerly of CHPR.
Hurwitz said that the JAMA study was an important validation of early milestones reached by the project and that CSI-RI has continued its momentum and growth since 2010, the last year covered by the study. In subsequent years, with the support of UMMS, the number of practices participating in the project has grown from five to 48 sites, reaching more than 250,000 Rhode Islanders. The project plans to add 20 additional practices over the next four years and double the number of residents covered by the initiative.
The UMMS team also conducted a strategic planning process that produced a five-year plan for CSI-RI and has played a critical role in developing contractual relationships between participating practices and private health insurers.
The authors of the JAMA article, led by Meredith Rosenthal, PhD, of the Harvard School of Public Health, found that the five original pilot sites studied saw improvements in a number of areas important to practices seeking to transform into patient-centered medical homes, including increasing access to care for patients, improving communication between physicians and patients, converting to electronic medical records, and improving care management and coordination for patients with chronic illnesses.
Researchers also noted a significant reduction in visits to emergency rooms for care that could be provided in a primary care setting (“ambulatory care sensitive”) for patients in practices participating in CSI-RI.
In the years since the study was completed, Hurwitz said that quality care measures for all of the participating practices have continued trending in the right direction. “We’ve seen improvements in the number of patients whose diabetes is well managed, an increase in patients whose high blood pressure is controlled and improvements in patients screened for depression and who receive tobacco cessations services,” she said.
Scores on how patients rate their experience of care have also improved, particularly in the areas of access, physician communication and office staff responsiveness.