Enhancing the quality of care for urban elders with diabetes and cardiovascular disease

Background: The management of older chronically ill patients dominates medical practice. We reorganized our Geriatric Ambulatory Practice to enhance their care using the Chronic Care Model. Methods: We established a disease registry for patients with diabetes and/or cardiovascular disease that centralizes patient information; evaluates disease management; measures outcomes; and provides reminders for patient education and preventive care. Results: We enrolled 410 patients >= 60 years of age: 262 with diabetes, 200 with cardiovascular disease, and 58 with both diseases. 62% were female; 63% were African American, 19% were White, and 8% were Hispanic/Latino. Although lipid testing (74%) exceeded that of Boston's elders cared for in other settings, systematic collection of quality indicators identified foot care and pneumovax administration as two important areas for improvement. Conclusion: Promoting more productive and systematic interactions between healthcare providers and patients can enhance quality of care for older chronically ill urban patients.