The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

Abstract

IntroductionThe Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation.MethodsWe conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies.ResultsThe 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies.ConclusionCCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making.

Mise en oeuvre d’un réseau intégré de prévention et de gestion du risque cardiométabolique en première ligne à Montréal : une plus grande coordination des soins avec les médecins de première ligne a-t-elle un impact sur les résultats de santé?

“…ont démontré qu'aucune des com posantes du CCM n'était responsable à elle seule des résultats du CCM et qu'il restait à déterminer quelle combinaison de ces composantes produit les meilleurs résul tats 24 . Toutefois, le fait de mettre en oeuvre plusieurs composantes du modèle s'est avéré associé à de meilleurs résultats chez les patients 5,24,25 .…”

“…ont démontré qu'aucune des com posantes du CCM n'était responsable à elle seule des résultats du CCM et qu'il restait à déterminer quelle combinaison de ces composantes produit les meilleurs résul tats 24 . Toutefois, le fait de mettre en oeuvre plusieurs composantes du modèle s'est avéré associé à de meilleurs résultats chez les patients 5,24,25 . Si notre étude ne permet pas de distinguer l'effet des différentes composantes du programme mis en place sur les résultats chez les patients, elle sug gère que la collaboration et la coordination des soins entre des équipes interdiscipli naires et les médecins de première ligne sont bénéfiques pour les patients.…”

Practice Context Affects Efforts to Improve Diabetes Care for Primary Care Patients: A Pragmatic Cluster Randomized Trial

“…2,3 There is a large body of evidence to support the effectiveness of the Chronic Care Model (CCM) as a framework to guide practice redesign efforts to improve care for patients with chronic diseases. [4][5][6][7][8] Although results from quality improvement (QI) efforts and cluster randomized trials are promising, implementation of practice transformations based on the CCM and patientcentered medical home (PCMH) in primary care practices has been challenging. [9][10][11] The considerable heterogeneity in outcomes of practice-focused interventions suggests that practice context, such as structural and demographic features and practice culture, may influence successful program implementation.…”

Improving Immunization Rates in a Hospital-Based Primary Care Practice

“…It combined elements of traditional QI, including the automated system for identifying target patients, with population management elements of registry use and care coordination. 25,26 Also consistent with the patient-centered medical home model was our multidisciplinary team-based structure that included social work. 27,28 Evidence suggests that multidisciplinary teams are a critical element of primary care transformation and improvement.…”