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Effect of Primary Health Care Orientation on Chronic Care Management

¹ Kaiser Permanente Northern California Division of Research, Oakland, Calif
² School of Public Health, University of California, Berkeley, Calif
³ Department of Family and Community Medicine, University of California, San Francisco, Calif

CORRESPONDING AUTHOR: Julie Schmittdiel, PhD, Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, Julie.A.Schmittdiel{at}kp.org

PURPOSE It has been suggested that the best way to improve chronic illness care is through a redesign of primary care emphasizing comprehensive, coordinated care as espoused by the Chronic Care Model (CCM). This study examined the relationship between primary care orientation and the implementation of the CCM in physician organizations.

METHODS The relationship between measures of primary care orientation and the CCM was examined in a sample of 957 physician organizations from the National Study of Physician Organizations, a cross-sectional telephone survey of all US medical groups and independent practice associations with 20 or more physicians (response rate, 70%).

RESULTS After adjusting for potential confounders, 6 of 8 measures of primary care orientation were associated with physician organizations’ adoption of 11 elements of CCM chronic care management. These 6 measures were severity of chronic illness treated in primary care, health promotion activity, health education activity, any accepted financial risk for hospitalization, required reporting, and presence of an electronic standardized problem list. Presence of an electronic medical record and the 5-year primary care physician turnover rate were not associated.

CONCLUSIONS Organizations that have adopted 6 core attributes of primary care, representing comprehensive health service delivery and a commitment to overall patient health, appear to use more chronic care management practices. Policy makers and other stakeholders may wish to focus on creating an improved primary care home in their quest to close the "quality chasm" in chronic illness care.

Key Words: Primary health care • Chronic Care Model • chronic disease • delivery of health care • quality of health care • health services research

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