Evidence On The Chronic Care Model In The New Millennium

Coleman, Katie; Austin, Brian T.; Brach, Cindy; Wagner, Edward H.

doi:10.1377/hlthaff.28.1.75

Cited by 1,340 publications

(1,130 citation statements)

References 27 publications

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“…[12][13][14][15][16][17][18] Outreach outside of physician visits, for example, has been shown to improve colorectal cancer screening, 19 increase influenza vaccination, 20,21 reduce medical costs and hospitalizations, 22 and improve care and health outcomes for patients with chronic care conditions. 23 Consumer e-health tools-electronic tools and services, including secure messaging between patients and providers, mobile health (mHealth) apps, and existing technologies used in novel ways-offer unique opportunities to improve patient-provider communication and facilitate patient engagement. [24][25][26] A growing body of evidence suggests that patient use of new technologies such as text messaging [27][28][29][30] or email 31 to communicate with healthcare providers can lead to behavior change and improved health outcomes for select patient populations.…”

Section: Introductionmentioning

confidence: 99%

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

et al. 2015

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BACKGROUND: As primary care moves toward a system of population health management, providers will need to engage patients outside traditional office-based interactions. OBJECTIVE: We assessed patient attitudes regarding technology use to communicate with their primary care team or to engage with other patients outside typical office settings. Design/Participants/Main Measures We c o n d u c t e d a n a t i o n a l s u r v e y u s i n g G f K KnowledgePanel ® to examine attitudes on the use of digital technology (email, text messaging, and social media such as Facebook and Twitter) to communicate with primary care teams about health behavior goals and test results. We also assessed attitudes toward the use of digital technologies to engage with other patients in activities such as peer coaching. KEY RESULTS: Of the 5119 panel members invited to participate, 3336 completed the survey (response rate, 65.2 %). Among respondents, more than half (58 %) reported using Facebook, and nearly two-thirds (64.1 %) used text messaging. Overall, few participants were willing to communicate about health goals via social media (3.1 %) or text messaging (13.3 %), compared to email (48.8 %) or phone (75.5 %) (results were similar for communication about test results). Among those that used text messaging, race/ethnicity was the only factor independently associated with greater support for text messaging [African American (OR 1.44; 95 % CI, 1.01-2.06) and Hispanic (OR 1.8; 95 % CI, 1.25-2.59)] in multivariate models. Participants interested in engaging in peer coaching through Facebook (11.7 %) were more likely to be younger (p<0.0001), female (p<0.001), and a racial/ ethnic minority (African American, non-Hispanic or Hispanic, p<0.0004). CONCLUSIONS: Despite regular use of new digital technology such as text messaging and social media, few participants supported using these tools for communicating with their physicians' practice. Participants were most supportive of using email for communication. Contrary to previous studies, among users of technology, low socioeconomic status and racial/ethnic minorities were equally or more likely to support use.

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Section: Introductionmentioning

confidence: 99%

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

et al. 2015

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“…In contrast, the community linkages and self‐management support themes received little attention (6% each). According to the program theory we devised3 and previous studies using the CCM framework,17, 18 a breadth of activities across the CCM is required to adequately effect change; therefore, the intervention as implemented lacked reach and, consequently, was inefficient in affecting the determinants of “prepared and proactive practice teams” and “better informed and engaged clients” (Figure 4). This was likely to have been a major contributor to lack of achievement of that trial's primary outcome of a doubling in the proportion of clients getting ≥80% of scheduled penicillin injections.…”

Section: Resultsmentioning

confidence: 99%

Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis

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Mitchell

Dassel

et al. 2018

JAHA

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BackgroundRheumatic heart disease is a high‐burden condition in Australian Aboriginal communities. We evaluated a stepped‐wedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed‐methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes.Methods and ResultsAn evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health‐center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of “action items,” which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health‐center staff, 22 informants, and 72 clients revealed barriers to achieving the trial's aims, including project‐level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing “self‐management support” and “community linkage” streams of the chronic care model. Increased momentum was evident in later stages of the study.ConclusionsThe program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.

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“…However, alternative explanations such as hospital policy, greater utilization management involvement or other factors must also be considered and may be more plausible. The data do underscore the importance of building care models that address access for both primary and for urgent care needs within the context of the Chronic Care Model 21,22 and the need for care management planning that addresses reasons for hospitalizations and emergency department use.…”

Section: Discussionmentioning

confidence: 95%

Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

et al. 2011

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Evidence On The Chronic Care Model In The New Millennium

Cited by 1,340 publications

References 27 publications

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis

Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

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