1. 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. Keeler 1 1 RAND Health 2 School of Public Health, UC Berkeley 3 National Center for Health Statistics January 7, 2004

2. M. Pearson, June 7, 2004-2 A Model for Chronic Illness Care Better Functional and Clinical Outcomes Delivery System Design Decision Support Clinical Information Systems Self-Management Support Health System Organization Links to Community Resources Informed, Activated Patient ProductiveInteractionsProductiveInteractions Prepared Practice Team

3. M. Pearson, June 7, 2004-3 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

4. M. Pearson, June 7, 2004-4 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

5. M. Pearson, June 7, 2004-5 Previous Findings Organizations made many changes With high CCM fidelity And modest depth –Averaged 50% of maximum depth possible –Best implementation = 76%

6. M. Pearson, June 7, 2004-6 Research Question What CCM strategies were emphasized - across all organizations? - by the ones that were most successful?

7. M. Pearson, June 7, 2004-7 CCM Emphasis Measurement Emphases were measured by 23 variables –% of an organizations changes in that area

8. M. Pearson, June 7, 2004-8 A Model for Chronic Illness Care Delivery System Design Decisio n Support Clinical Information Systems Self-Management Support Health System Organization Links to Community Resources Leadership support Provider participation Coherent system QI Guidelines Provider education Expert support Registry Info for care man. Performance data Care man. roles Practice team Care coordination Proactive follow-up Planned visit Visit system changes Patient education Patient activation Self-man assessment Self-man resources Collaboration on decisions Guidelines to patients For patients For community

9. M. Pearson, June 7, 2004-9 CCM Emphasis Measurement Emphases were measured by 23 variables –% of an organizations changes in that area Success was measured by the implementation depth rating Analyses: –Bivariate correlations –Stepwise regression of success on emphases

10. M. Pearson, June 7, 2004-10 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)

11. M. Pearson, June 7, 2004-11 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

12. M. Pearson, June 7, 2004-12 CCM Emphases Related To Success: Multivariable Analysis Dependent Variable = Overall Depth Rating Model Stan. Coeff. P-value - Practice team - Collaborative decision making with patients - Traditional patient education +.44.001 +.31.021 -.28.039 R² =.37

13. M. Pearson, June 7, 2004-13 Summary The organizations that most comprehensively implemented CCM Emphasized practice teams and collaborative decision making with patients De-emphasized traditional patient education

14. M. Pearson, June 7, 2004-14 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

15. M. Pearson, June 7, 2004-15 For additional information: See: http://www.rand.org/health/ICICE E-mail: mpearson@rand.org