1. Alberta’s Caring for Diabetes (ABCD) Project A Chronic Disease Management Initiative Jeffrey Johnson, PhD Canada Research Chair in Diabetes Health Outcomes Professor, Public Health Sciences University of Alberta

3. Alberta’s Diabetes Strategy 2003-2013 Primary Prevention (HAC) 2 o & 3 o Prevention AMFH – Supplies Screening FN Off- Reserve (MDSI) ABCD Project May 2003 October 2003

4. Alberta’s Caring for Diabetes (ABCD) Project CDM Intervention - patient enrollment - annual follow-up ADSS Alberta DM Atlas 2007 2009 2011 Regional Labs Lab Linkage -region profiles -MD profiles

5. ABCD Project AHW & IHE/ACHORD partnership  $5.2 million from AHW; 2008-2013 Collaborative CDM initiatives  Working with RHA/PCN  Contribution of funding to support collaborative CDM initiatives Aim: to improve quality and efficiency of diabetes care in Alberta

6. Key Data Linkages… ADSS administrative data Regional Lab data  Lipids  A1C  ACR PCN/clinic charts (EMR/paper charts) Patient-reported data (self-report survey)  ABCD Cohort (n=5,000) – 1/3 of non-metro pop’n Alberta’s Caring for Diabetes (ABCD) Project

7. ADSS Active Dissemination Northern Lights Region (Wood Buffalo/Fort McMurray) April Peace Country TBA Aspen (Westlock ) June East Central TBA DTHR (Red Deer) March Lethbridge (Chinook) Aug 07 Palliser Jan, Feb, April 25 Capital Ongoing Calgary Ongoing

8. Key Features… Evidence Based QI Intervention  DOVE Study to Rural health regions  CDA-CPG dissemination/implementation Enhanced surveillance  Capitalizing on the ADSS  Integrating data sources - Administrative, Laboratory, Clinical, PRO  Performance measurement & benchmarking Integration with RHA/PCN planning  Developing PCN practices  Concurrent ‘disease management’ programs Enhanced QI Intervention/Evaluation  Controlled comparisons of new interventions  Collaborative development of interventions ABCD and RHA/PCNs…

9. ABCD Baseline QISD Measurement 1-year QISD Measurement 2-year QISD Measurement Standard CDA - CPG Dissemination DOVE Intervention DOVE Intervention + A&F N= 2 RHAs n=1660 N= 2 RHAs n=1660 N= 2 RHAs n=1660 XXXXXXXXXXXX XX\X\X\X\XXX\X\X\X\X Enhanced QI Intervention & Evaluation …

10. Incidence of MI/Stroke Treatment Quality Improvement Intervention Control No Intervention … a province-wide health services research laboratory! DOVE Diabetes Outreach Van Enhancement Study Enhanced QI Intervention & Evaluation …

11. Jan – June 2008ADSS Dissemination (RHA/PCN) March 2008 funding received @ IHE August 2008Initial staffing Sept - Dec 2008RHA Laboratory Surveillance QISD development Staffing Spring 2009Implementation (lab surveillance) - academic detailing - audit & feedback (ADSS Atlas 2009) Annually to 2012 ABCD - time line…

12. AH&W ACHORD/IHE ABCD Project Regional Integration Groups ABCD Management Team a CE&E Steering Committee b a ABCD Management Team would be based at ACHORD offices at the Alberta Diabetes Institute, University of Alberta in Edmonton. b Clinical Evidence and Evaluation Steering Committee will be responsible for the overall implementation and evaluation of the ABCD Project ABCD - Org Chart …

13. Coordination of programs  PCN initiated programs  DNPC  Stroke Prevention Strategy  MDSI  Quality indicators…which set…?  Many more, …. RHAs versus PCNs…? Professional autonomy…?  Big city specialists….  Involving AMA/TOPP…? Regional buy-in …  Local resources  Integration outside “health care” Sustainability… ABCD - challenges …

14. ? jeff.johnson@ualberta.ca www.ACHORD.ca Questions…