January 7, 2004

1. Chronic Care Model Implementation EmphasesM. L. Pearson,1 S. Wu,1 S.M. Shortell,2 J.A. Marsteller,3P.J. Mendel,1 M. Lin,2 E.B. Keeler11RAND Health2School of Public Health, UC Berkeley3National Center for Health Statistics January 7, 2004

2. Productive Interactions Informed, Activated Patient Prepared Practice Team A Model for Chronic Illness Care Health System Organization Delivery System Design Self-Management Support Decision Support Clinical InformationSystems Links to Community Resources Better Functional and Clinical Outcomes

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. 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. Previous Findings • Organizations made many changes • With high CCM fidelity • And modest depth • Averaged 50% of maximum depth possible • Best implementation = 76%

6. Research Question What CCM strategies were emphasized - across all organizations? - by the ones that were most successful?

7. CCM Emphasis Measurement • Emphases were measured by 23 variables • % of an organization’s changes in that area

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

9. Emphases were measured by 23 variables % of an organization’s changes in that area CCM Emphasis Measurement • Success was measured by the implementation depth rating • Analyses: • Bivariate correlations • Stepwise regression of success on emphases

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. CCM Emphases Related to Success: Bivariate Analysis

12. CCM Emphases Related To Success: Multivariable Analysis

13. Summary The organizations that most comprehensively implemented CCM • Emphasized practice teams and collaborative decision making with patients • De-emphasized traditional patient education

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. For additional information: • See: http://www.rand.org/health/ICICE • E-mail: mpearson@rand.org