Assessing integration in diabetes care: utility of the instrument IEMAC-ARCHO

• Published in: International journal of integrated care 2016-12, Vol.16 (6), p.135
• Main Authors: Fernández-Cano, Paloma, Solas-Gaspar, Olga, Guilabert-Mora, Mercedes, Mira-Solves, José Joaquín, Nuño-Solinís, Roberto
• Format: Article
• Language: English
• Subjects: Decision making; Diabetes; Endocrinology; Hospitals; Information systems; Multidisciplinary teams; Patients; Primary care; Professionals
• ISSN: 1568-4156; 1568-4156
• DOI: 10.5334/ijic.2684

Introduction: Diabetes care faces enormous challenges due to the progressiveness and multiple manifestations and complications of the disease, which make necessary the coordination of numerous professionals from different settings around the diabetic patient. The current structure and functioning of diabetes care in many Spanish regions, mainly fragmented through primary care centers, departments of endocrinology and other hospital specialties, social care and a variety of support professionals is an obstacle to provide optimal care. The existence of new chronic care frameworks that have rendered better outcomes in other settings and the development of instruments to make them operational in our healthcare system is an opportunity to improve diabetes care.Description of practice change implemented: The program Advanced Diabetes Care Centers (ADCC) was developed to: a) improve integration between primary and hospital care; b) foster patient self-care management and c) establish personalized care plans. ADCC creates _virtual organizations_ with the professionals who provide diabetes care to patients within a defined geographic area. An ADCC is usually composed by primary care physicians and nurses of several primary care centers together with endocrinologists and specialty nurses of the department of endocrinology of their reference hospital and professionals that participate in diabetes care, such as ophthalmologists, pharmacists and others, all belonging to the same health area. ADCC program is supported by MSD having the commitment of the respective health area management.Starting in 2014, ADCC have been established progressively in several regions, existing now around 25 centers. The nature and scope of the specific improvement interventions introduced in each center are left at the decision of each multidisciplinary team after a thorough diagnosis of the baseline situation and a prioritization exercise. To make the baseline assessment, a 5 hour structured session using IEMAC-ARCHO Diabetes is held among the ADCC members.IEMAC- ARCHO (Assessment of Readiness for Chronicity of Health Care Organizations) www.iemac.org is an instrument developed to facilitate HC Organizations changes towards better care for chronic patients. Based on the Chronic Care Model, it also incorporates a population based, systemic (from health promotion to social care) approach with risk stratification and ICT use. IEMAC-ARCHO is a generic instrument suitable for all type of macro