There is extensive content on improving access in the Office Practices: Primary Care Access section of IHI.org.  A good first step for getting started is to familiarize yourself with the Model for Improvement, a simple yet powerful tool for accelerating improvement, and to create an aim statement for your effort. 

In working with many systems to redesign care, we have noticed that most organizations follow these general steps:

• Build the improvement team from staff actively involved in patient care.
• Find a guideline and adapt it to your setting. 
• Use the guideline to build a measurement system.
• Review the guideline for care that needs to be delivered and assign roles and tasks to the team.
• Call in one patient and hold a planned visit, covering all the topics on your guideline.
• During the planned visit, review clinical goals with the patient and set self-management goals with the patient.  (Self-management goals are patient determined and are based on patient concerns.)
• Follow-up with the patient at the predetermined interval.
• Feed the data from the planned visit back into an information system.
• Holding one planned visit can be the beginning of total system redesign. 

See the Changes section for principles to refer to while redesigning care, or visit the Improving Chronic Illness Care website for a downloadable version of the Chronic Care Change package.

Try the National Guideline Clearinghouse, an initiative of  the Agency for Healthcare Research and Quality. Review the guidelines for their adaptability to your situation, the originator, and the evidence used to support them.

Yes!  Having your schedules open and your clinic operating more smoothly will enhance your ability to provide planned care.  Consider planned care visits (often booked in advance) as “good backlog.”  This is the work that needs to be done in primary care.  If your schedules are more open, you can also take advantage of each patient visit and perform more services that are indicated by guidelines if you have created an information system and trained staff to capitalize on such opportunities.  Advanced access can also create time for some staff members to engage in population-based review and follow-up phone calls to support patient self-management efforts.

See the Office Practices: Primary Care Access section for more information on strategies for building a sustainable system for improved patient access.

On the Improving Chronic Illness Care website, there is an extensive bibliography of peer-reviewed literature that supports the Chronic Care Model.

It depends on whether or not your EMR has the following functionality typically found in registries:

• Ability to identify condition populations and sub-populations for needed care
• Produce population reports that can be segmented by clinical indicators and disease severity
• Produce patient summaries that incorporate all patient co-morbidities
• Can capture outcomes by provider

For a more comprehensive review of registry functionality, see the Registry Evaluation Form on the Improving Chronic Illness Care website.

We are not able to keep up with the new products, freeware, and homegrown registries that are currently available.  If you would like information on choosing a registry, please refer to the California HealthCare Foundation's website for the following:

• Chronic Disease Registries: A Product Review (May 2004)
• Paper entitled "Using Computerized Registries in Chronic Disease Care" (February 2004)

Also, for a more comprehensive review of registry functionality see the Registry Evaluation Form on the Improving Chronic Illness Care website.

Yes, others have recognized that the Chronic Care Model has useful lessons for the redesign of health care in a wide variety of settings and for multiple clinical concerns and irregardless of clinical topic.  Two articles have been published that describe the utility of the model for prevention topics:

Glasgow R, Orleans CT, Wagner EH, et al. Does the Chronic Care Model serve also as a template for improving prevention? Milbank Quarterly. 2001;79(4):579-612.

Goins KV, Zapka JG, Geiger AM, et al. Implementation of systems strategies for breast and cervical cancer screening services in health maintenance organizations. American Journal of Managed Care. 2003;9:745.

Since the model is simply a way of organizing principles from effective research studies, it seems to be broadly applicable.  Organizations have used it for diabetes, asthma, chronic heart failure, depression, cardiovascular disease, prevention of frailty in the elderly, oral health, cancer screening, HIV, diabetes prevention, and immunizations.