Improving Chronic Illness Care: Translating Evidence Into Action

Wagner, Edward H.; Austin, Brian T.; Davis, Connie L.; Hindmarsh, Michael; Schaefer, Judith; Bonomi, Amy E.

doi:10.1377/hlthaff.20.6.64

Cited by 2,767 publications

(2,504 citation statements)

References 14 publications

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“…Our continuing care model is consistent with the chronic care model, a frequently advocated chronic illness management framework (37) that has been adapted to self-management office-based programs for several chronic illnesses and that has been shown to improve health outcomes, including for patients with mood disorders such as depression (38). Findings of this study suggest long-term beneficial effects of adapting such a model for continuing care of individuals with substance use disorders.…”

Section: Discussionmentioning

confidence: 99%

Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care-Based Model

Felicia¹,

Parthasarathy²,

Mertens³

et al. 2011

Psychiatric Services

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Objectives How best to provide ongoing services to patients with substance use disorders to sustain long-term recovery is a significant clinical and policy question that has not been adequately addressed. Analyzing nine years of prospective data for 991 adults who entered substance abuse treatment in a private, nonprofit managed care health plan, this study aimed to examine the components of a continuing care model (primary care, specialty substance abuse treatment, and psychiatric services) and their combined effect on outcomes over nine years after treatment entry. Methods In a longitudinal observational study, follow-up measures included self-reported alcohol and drug use, Addiction Severity Index scores, and service utilization data extracted from the health plan databases. Remission, defined as abstinence or non-problematic use, was the outcome measure. Results A mixed-effects logistic random intercept model controlling for time and other covariates found that yearly primary care, and specialty care based on need as measured at the prior time point, were positively associated with remission over time. Persons receiving continuing care (defined as having yearly primary care and specialty substance abuse treatment and psychiatric services when needed) had twice the odds of achieving remission at follow-ups (p<.001) as those without. Conclusions Continuing care that included both primary care and specialty care management to support ongoing monitoring, self-care, and treatment as needed was important for long-term recovery of patients with substance use disorders.

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Section: Discussionmentioning

confidence: 99%

Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care-Based Model

Felicia¹,

Parthasarathy²,

Mertens³

et al. 2011

Psychiatric Services

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“…We hypothesized that barriers to adherence would be amenable to a health system intervention, based on elements of the chronic care model (CCM)12 and using continuous quality improvement (CQI) processes. The CCM for chronic disease management incorporates 6 domains: health systems, delivery system design, decision support, clinical information systems, self‐management support, and community linkages 12.…”

Section: Introductionmentioning

confidence: 99%

“…The CCM for chronic disease management incorporates 6 domains: health systems, delivery system design, decision support, clinical information systems, self‐management support, and community linkages 12. These domains have high applicability to ARF/RHD management.…”

Section: Introductionmentioning

confidence: 99%

Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High‐Burden Setting: Outcome of a Stepped‐Wedge, Community, Randomized Trial

Ralph

Dassel

Kirby

et al. 2018

JAHA

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BackgroundHealth system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease.Methods and ResultsWe undertook a stepped‐wedge, randomized trial in northern Australia. Five pairs of Indigenous community clinics entered the study at 3‐month steps. Study phases comprised a 12 month baseline phase, 3 month transition phase, 12 month intensive phase and a 3‐ to 12‐month maintenance phase. Clinics received a multicomponent intervention supporting activities to improve penicillin delivery, aligned with the chronic care model, with continuous quality‐improvement feedback on adherence. The primary outcome was the proportion receiving ≥80% of scheduled penicillin injections. Secondary outcomes included “days at risk” of acute rheumatic fever recurrence related to late penicillin and acute rheumatic fever recurrence rates. Overall, 304 patients requiring prophylaxis were eligible. The proportion receiving ≥80% of scheduled injections during baseline was 141 of 304 (46%)—higher than anticipated. No effect attributable to the study was evident: in the intensive phase, 126 of 304 (41%) received ≥80% of scheduled injections (odds ratio compared with baseline: 0.78; 95% confidence interval, 0.54–1.11). There was modest improvement in the maintenance phase among high‐adhering patients (43% received ≥90% of injections versus 30% [baseline] and 28% [intensive], P<0.001). Also, the proportion of days at risk in the whole cohort decreased in the maintenance phase (0.28 versus 0.32 [baseline] and 0.34 [intensive], P=0.001). Acute rheumatic fever recurrence rates did not differ between study sites during the intensive phase and the whole jurisdiction (3.0 versus 3.5 recurrences per 100 patient‐years, P=0.65).ConclusionsThis strategy did not improve adherence to rheumatic heart disease secondary prophylaxis within the study time frame. Longer term primary care strengthening strategies are needed.Clinical Trial Registration URL: http://www.anzctr.org.au. Unique identifier: ACTRN12613000223730.

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“…The Chronic Care model and the Institute of Medicine have established self-management programs as a necessary component of good care for persons with chronic disease (1)(2)(3)(4)(5). Within the model, such programs are known as self-management support, which is how providers and systems support patients in their self-management efforts.…”

Section: Introductionmentioning

confidence: 99%

A disease‐specific self‐help program compared with a generalized chronic disease self‐help program for arthritis patients

Lorig¹,

Ritter²,

Plant³

2005

Arthritis & Rheumatism

221

212

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Objective. Both the Arthritis Self-Management Program (ASMP) and the generic Chronic Disease Self-Management Program (CDSMP) have been shown to be successful in improving conditions in patients with arthritis. This study compared the relative effectiveness of the 2 programs for individuals with arthritis. Methods. Patients whose primary disease was arthritis were randomized to the ASMP (n ‫؍‬ 239) or to the CDSMP (n ‫؍‬ 116). Analyses of covariance were used to compare the outcome measures for the 2 programs at 4 months and 1 year. Measures included quality of life outcomes (self reported, health distress, disability, activity limitation, global health, pain, and fatigue), health behaviors (practice of mental stress management, stretching and strength exercise, aerobic exercise), self efficacy, and health care utilization (physician visits and hospitalizations). Results. Both programs showed positive results. The disease-specific ASMP appeared to have advantages over the more generic CDSMP for patients with arthritis at 4 months. These advantages had lessened slightly by 1 year. Conclusion. The disease-specific ASMP should be considered first where there are sufficient resources and participants. However, both programs had positive effects, and the CDSMP should be considered a viable alternative. KEY WORDS. Patient education; Self management; Arthritis; Randomized trial. INTRODUCTIONThe Chronic Care model and the Institute of Medicine have established self-management programs as a necessary component of good care for persons with chronic disease (1-5). Within the model, such programs are known as self-management support, which is how providers and systems support patients in their self-management efforts. Over the past 2 decades, there have been many examples of effective self-management support (2,6). Most of these programs have been disease specific, whereas a few are more generic. One of the major questions arising from past self-management studies is how to best understand the effectiveness of different programs. In this report, we examine the specific issue of the relative effectiveness of a disease-specific self-management program versus a generic self-management program for individuals with arthritis and discuss the policy implications for the findings.The Arthritis Self-Management Program (ASMP), also known as the Arthritis Self-Help Course and Challenging Arthritis, is now more than 25 years old. It has been found to be useful for persons with arthritis (7-9).In the past 10 years, the Chronic Disease Self-Management Program (CDSMP), also known as the Expert Patient Program, has been developed and evaluated (8,10,11). Unlike the ASMP, the CDSMP is a generic program that individuals with many different types of chronic conditions attend at the same time. In an initial randomized study, persons with arthritis who attended the CDSMP workshop showed improvements in health behaviors and health status (12). Both the ASMP and the CDSMP are large programs in the United States, Great Britain, Australia, New Zeala...

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Improving Chronic Illness Care: Translating Evidence Into Action

Cited by 2,767 publications

References 14 publications

Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care-Based Model

Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care-Based Model

Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High‐Burden Setting: Outcome of a Stepped‐Wedge, Community, Randomized Trial

A disease‐specific self‐help program compared with a generalized chronic disease self‐help program for arthritis patients

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