The Chronic Care Model and Relationships to Patient Health Status and Health-Related Quality of Life

Hung, Dorothy; Glasgow, Russell E.; Dickinson, L. Miriam; Froshaug, Desireé B.; Fernald, Douglas H.; Balasubramanian, Bijal A.; Green, Larry A.

doi:10.1016/j.amepre.2008.08.009

Cited by 42 publications

(33 citation statements)

References 19 publications

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“…The study further suggests that shifting away from the traditional fee-for-service practice can be beneficial for care of chronic diseases (Liddy et al 2011). Organizational attributes can affect processes of care and influence patient outcomes (Hogg et al 2008;Hung et al 2006Hung et al , 2008. However, the association between organizational models and the level of assessment of chronic care has not been evaluated.…”

Section: Résumémentioning

confidence: 99%

Variations in Patients’ Assessment of Chronic Illness Care across Organizational Models of Primary Healthcare: A Multilevel Cohort Analysis

Lévesque¹,

Feldman²,

Lemieux³

et al. 2012

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Variations in Patients' Assessment of Chronic Illness Care AbstractPurpose: To measure patients' assessment of chronic illness care and its variation across primary healthcare (PHC) models. Methods: We recruited 776 patients with diabetes, heart failure, arthritis or chronic obstructive pulmonary disease from 33 PHC clinics. Face-to-face interviews, followed by a telephone interview at 12 months, were conducted using the Patient Assessment of Chronic Illness Care (PACIC). Multilevel regression was used in the analysis. Results: The mean PACIC score was low at 2.5 on a scale of 1 to 5. PACIC scores were highest among patients affiliated with family medicine groups (mean, 2.78) and lowest for contact models (mean, 2.35). Patients with arthritis and older persons generally reported a lower assessment of chronic care. Conclusion: Family medicine groups represent an integrated model of PHC associated with higher levels of achievement in chronic care. variations across PHC organizations suggest that some models are more appropriate for improving management of chronic illness. RésuméObjet : Mesurer l' évaluation par les patients des soins pour les maladies chroniques et repérer les variations parmi les modèles de soins de santé primaires (ssP). Méthode : nous avons recruté, auprès de 33 cliniques de ssP, 776 patients atteints de diabètes, d'insuffisance cardiaque, d' arthrite ou de maladie pulmonaire obstructive chronique. À l' aide du PACIC (Patient Assessment of Chronic Illness Care), nous avons mené des entrevues en personne, suivies d' entrevues téléphoniques douze mois plus tard. L' analyse a été faite par régression multiniveaux. Résultats : L'indice moyen du PACIC était bas, avec 2,5 points sur une échelle de 1 à 5. Les plus hauts indices du PACIC se trouvent chez les patients affiliés à des groupes de médecine de famille (moyenne, 2,78) et les indices les plus bas se retrouvent dans les modèles de contact (moyenne, 2,35). L' évaluation des soins chroniques est moindre, en général, chez les patients atteints d' arthrite et chez les personnes âgées. Conclusion : Les groupes de médecine de famille représentent un modèle intégré de ssP associé à de plus hauts niveaux d' accomplissement des soins chroniques. La variation parmi les organisations de ssP laisse voir que certains modèles sont plus appropriés pour l' amélioration de la gestion des maladies chroniques.

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Section: Résumémentioning

confidence: 99%

Variations in Patients’ Assessment of Chronic Illness Care across Organizational Models of Primary Healthcare: A Multilevel Cohort Analysis

Lévesque¹,

Feldman²,

Lemieux³

et al. 2012

hcpol

View full text Add to dashboard Cite

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“…In particular, there has been an emphasis on effective and Debbie Ehrmann Feldman et al efficient healthcare delivery for persons with chronic health problems, especially from their primary care providers (morgan et al 2007;Russell et al 2009). A main reason for this focus is that chronic conditions have significant adverse consequences on health outcomes and functioning (Yach et al 2004), but adequate management can moderate their impact on quality of life and reduce the burden of the disease (Hung et al 2008). Health status and health-related quality of life (HRqoL) are important outcome measures for patients with chronic conditions (Lam and Lauder 2000) and have been found to be linked with healthcare utilization and mortality (schraeder et al 2001).…”

Section: Résumémentioning

confidence: 99%

“…Recent literature suggests that the way primary healthcare (PHC) is organized may influence patient health outcomes, and that structured care incorporating such elements as health system integration, enhanced clinical information systems and self-management support can optimize clinical outcomes for patients with chronic disease (Bosch et al 2009;Hung et al 2008;scott et al 2004). The Chronic Care model, which is now widely recognized as a framework for optimizing chronic care, has incorporated these elements into its core dimensions (Wagner et al 2001).…”

Section: Résumémentioning

confidence: 99%

Primary Healthcare Organization and Quality-of-Life Outcomes for Persons with Chronic Disease

Feldman

Lévesque²,

Lemieux³

et al. 2012

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Purpose: To explore the association between primary healthcare (PHC) organizational model and health-related quality of life (HRqoL) in persons with chronic disease. Methods: We recruited 776 patients with a primary diagnosis of one of four chronic diseases from 33 PHC clinics. Patients were interviewed at baseline, 6, 12 and 18 months. We categorized PHC model by administrative type and by a taxonomy according to organizational attributes. HRqoL was measured by disease-specific questionnaires. Results: mean age was 67 years and 55.3% were female. PHC models differed with respect to case mix: community models served older patients with higher co-morbidity and lower health status. multilevel logistic regression revealed that none of the PHC organizational models was associated with HRqoL. Having fewer co-morbidities, higher self-rated health and not using home care services were associated with higher HRqoL. Conclusion: Despite their having patients with more complex health problems, HRqoL in patients of community practices was equivalent to that of patients in other types of PHC organizations.

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“…These domains and items were derived from previous primary care research studies and demonstration projects focused on improving quality and from the National Ambulatory Medical Care Survey Electronic Medical Records Questionnaire. 18,[42][43][44][45][46][47] The survey assessed practice characteristics (eg, size, ownership, location), factors external to the practice (eg, participation in demonstration projects, accountable care organizations [ACOs], or external incentive programs for reporting quality), and factors internal to the practice (eg, health information technology characteristics, use of clinical quality data for reporting and QI, and use of evidence in practice). See the Supplemental Table 1, available at http://www.…”

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confidence: 99%

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

et al. 2018

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PURPOSE Improving primary care quality is a national priority, but little is known about the extent to which small to medium-size practices use quality improvement (QI) strategies to improve care. We examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US states to improve quality of care for heart health and assessed factors associated with those variations. METHODSIn this cross-sectional study, practice characteristics were assessed by surveying practice leaders. Practice use of QI strategies was measured by the validated Change Process Capability Questionnaire (CPCQ) Strategies Scale (scores range from -28 to 28, with higher scores indicating more use of QI strategies). Multivariable linear regression was used to examine the association between practice characteristics and the CPCQ strategies score. RESULTSThe mean CPCQ strategies score was 9.1 (SD = 12.2). Practices that participated in accountable care organizations and those that had someone in the practice to configure clinical quality reports from electronic health records (EHRs), had produced quality reports, or had discussed clinical quality data during meetings had higher CPCQ strategies scores. Health system-owned practices and those experiencing major disruptive changes, such as implementing a new EHR system or clinician turnover, had lower CPCQ strategies scores.CONCLUSION There is substantial variation in the use of QI strategies among small to medium-size primary care practices across 12 US states. Findings suggest that practices may need external support to strengthen their ability to do QI and to be prepared for new payment and delivery models. INTRODUCTIONH ealth care delivery is evolving in the United States, with increasing emphasis on insurance payments based on improving quality instead of merely delivering health care services. 1 This emphasis has brought a greater focus on population health management, quality measurement, and health care outcomes. Primary care practices use quality improvement (QI) strategies, such as monitoring and assessing outcomes, having skilled QI teams, and using system redesigns to improve patient and population health outcomes, system performance, and clinician experience, and to reduce health care costs.2-6 Implementing QI strategies can help practices deliver appropriate health services efficiently and improve health outcomes, [7][8][9][10] yet much of what we know about the use of QI strategies in medical care comes from surveys conducted mostly in hospitals and health systems. [11][12][13][14][15][16][17] Little is known about the use of QI strategies in small to medium-size primary care practices, where more than one-half of Americans receive care for their chronic conditions. 18 Earlier studies have lacked generalizability because of small sample sizes and limited contextual diversity. Better understanding of the prevalence and reasons for variation in use of QI strategies among smaller practices is needed...

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The Chronic Care Model and Relationships to Patient Health Status and Health-Related Quality of Life

Cited by 42 publications

References 19 publications

Variations in Patients’ Assessment of Chronic Illness Care across Organizational Models of Primary Healthcare: A Multilevel Cohort Analysis

Variations in Patients’ Assessment of Chronic Illness Care across Organizational Models of Primary Healthcare: A Multilevel Cohort Analysis

Primary Healthcare Organization and Quality-of-Life Outcomes for Persons with Chronic Disease

Use of Quality Improvement Strategies Among Small to Medium-Size US Primary Care Practices

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