Chronic Care Model Implementation
Emphases
M. L. Pearson,1 S. Wu,1 S.M. Shortell,2 J.A. Marsteller,3
P.J. Mendel,1 M. Lin,2 E.B. Keeler1
1RAND
Health
2School of Public Health, UC Berkeley
3National Center for Health Statistics
January 7, 2004
A Model for Chronic Illness Care
Health System Organization
Delivery
System
Design
Self-Management
Support
Decision
Support
Clinical
Information
Systems
Links to Community Resources
Informed,
Activated
Patient
Productive
Interactions
Prepared
Practice
Team
Better Functional and Clinical Outcomes
M. Pearson, June 7, 2004-2
Improving Chronic Illness Care Evaluation
(ICICE)
• Objectives are to evaluate
– Success of QI collaboratives in inducing
changes to implement the Chronic Care Model
(CCM)
– Effects of these changes on processes and
outcomes of care
• Funded by RWJF
M. Pearson, June 7, 2004-3
Analysis of Change Activities
• Sample
– 41 organizations in QI collaboratives
– CHF, Diabetes, Depression, and Asthma
• Data sources for coding
- Monthly progress reports
- Phone interviews
- Meeting materials
• Implementation variables
- Quantity of changes
- Depth
- CCM emphases
M. Pearson, June 7, 2004-4
Previous Findings
• Organizations made many changes
• With high CCM fidelity
• And modest depth
– Averaged 50% of maximum depth possible
– Best implementation = 76%
M. Pearson, June 7, 2004-5
Research Question
What CCM strategies were emphasized
- across all organizations?
- by the ones that were most successful?
M. Pearson, June 7, 2004-6
CCM Emphasis Measurement
• Emphases were measured by 23 variables
– % of an organization’s changes in that area
M. Pearson, June 7, 2004-7
A Model for Chronic Illness Care
Care man. roles
Leadership support
Practice team
Provider participation
Care coordination
Coherent system QI
Proactive follow-up
Guidelines
Provider education
Expert support
Planned visit
Health System
Organization
Visit system changes
Delivery
System
Design
Self-Management
Support
Decisio
n
Support
Links to Community Resources
Clinical
Information
Systems
Patient education
Patient activation
Self-man assessment
Self-man resources
Collaboration on decisions
Guidelines to patients
For patients
Registry
For community
Info for care man.
Performance data
M. Pearson, June 7, 2004-8
CCM Emphasis Measurement
• Emphases were measured by 23 variables
– % of an organization’s changes in that area
• Success was measured by the implementation
depth rating
• Analyses:
– Bivariate correlations
– Stepwise regression of success on emphases
M. Pearson, June 7, 2004-9
Findings
• Wide range of emphases
– Emphasis on each of 23 strategies varied by
organization (p < .001)
• Mean emphasis on single strategy ranged from
– < 1% (e.g., practice team; guidelines to patients)
– 9% (e.g., registry; guideline institutionalization)
M. Pearson, June 7, 2004-10
CCM Emphases Related to Success:
Bivariate Analysis
CCM Strategy
Corr.
Coef.
P-value
Practice team
+0.45
.003
Collaborative decision
making with patients
+0.34
.011
Traditional patient
education
-0.39
.028
M. Pearson, June 7, 2004-11
CCM Emphases Related To Success:
Multivariable Analysis
Dependent Variable =
Overall Depth Rating
Model
- Practice team
- Collaborative decision
making with patients
- Traditional patient
education
Stan.
Coeff.
P-value
+ .44
.001
+ .31
.021
- .28
.039
R² = .37
M. Pearson, June 7, 2004-12
Summary
The organizations that most comprehensively
implemented CCM
• Emphasized practice teams and collaborative
decision making with patients
• De-emphasized traditional patient education
M. Pearson, June 7, 2004-13
Implications
To fully implement CCM
• Organizations should be encouraged to direct more
change activities towards certain CCM strategies,
especially practice teams and patient collaboration
• Collaborative facilitators and organization leaders
should consider increased training and resources
in support of these strategies
M. Pearson, June 7, 2004-14
For additional information:
• See: http://www.rand.org/health/ICICE
• E-mail: mpearson@rand.org
M. Pearson, June 7, 2004-15