Chronic Disease Management Collaboratives

The Health Quality Council led two Collaboratives that brought together practitioners in Saskatchewan to focus on chronic disease management to learn and share ideas on improving their practices, based on evidence-based research.  

What is a Collaborative

A Collaborative is an improvement methodology or learn-by-doing approach to quality improvement. A Collaborative is a focused effort, over a focused period of time, across multiple teams to multiply the learning and improvement. It brings together practitioners from various disciplines and multiple sites to learn and share ideas on improving their practices, based on evidence-based research. Collaboratives involve a combination of theory and hands-on practice that help participants work to address challenges in their work environments while also building capacity for quality improvement methodology. Collaboratives have been around since the 1980s and used to target complex, large-scale changes across a variety of organizations across the world. While there are many variations of a Collaborative approach, typically they all share the same key elements: shared goals, shared measures, and shared learning.

Chronic Disease Management Collaborative I: Diabetes and Coronary Artery Disease Care

The first Chronic Disease Management Collaborative ran from 2005 to 2008, which involved approximately 15,000 people living with diabetes and coronary artery disease, 13 regional health authorities, more than 25% of all family physicians in Saskatchewan, and hundreds of other health care workers, including nurse practitioners, nurses, educators, pharmacists, dietitians, and First Nations and Métis groups. Together the group focused on improving diabetes and coronary artery disease care and using clinical practice redesign to improve access to family physician visits. At the time, this Chronic Disease Management Collaborative was Saskatchewan’s largest quality improvement initiative and one of the largest national improvement projects in Canada. As a result of the Collaborative, over 18,000 patients received better care and access to care and experienced better health outcomes.

Chronic Disease Management Collaborative II: Chronic Obstructive Pulmonary Disease and Depression

The success of the first Chronic Disease Management Collaborative led to requests for another Collaborative, and so the second Chronic Disease Management Collaborative was created in response. In 2010, the Health Quality Council brought together approximately 50 family practices and 170 other care providers such as nurse practitioners, specialists and office managers, for the second Chronic Disease Management Collaborative. This Collaborative was aimed at improving the quality of care for people living with Chronic Obstructive Pulmonary Disease (COPD) and depression. This Collaborative supported improvement work that led to more accurate diagnosis, treatment, and monitoring for thousands of patients.