| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 HealthPartners Research Foundation, Minneapolis, Minn
2 HealthPartners Medical Group, Minneapolis, Minn
3 Robert Wood Johnson Medical School, New Brunswick, NJ
CORRESPONDING AUTHOR: Mary C. Hroscikoski, MD, MS HealthPartners Research Foundation PO Box 1524, MS#21111R Minneapolis, MN 55440-1524 maryosf{at}gmail.com
Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.
PURPOSE The Chronic Care Model (CCM) provides a conceptual framework for transforming health care for patients with chronic conditions; however, little is known about how to best design and implement its specifics. One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues.
METHODS We conducted a qualitative, comparative case study of 5 of 18 group clinics 18 to 23 months after the implementation began. Built on knowledge of the clinics from a previous study of advanced access implementation, data included in-depth interviews with organizational leaders and varied clinic personnel, observation of clinic care processes, and review of written materials.
RESULTS Relatively small and highly variable care process changes were made during the study period. The change process underwent several marked shifts in strategy when initial efforts failed to achieve much and bore little resemblance to the change process used in the previously successful large-scale implementation of advanced access scheduling. Many barriers were identified, including too many competing priorities, a lack of specificity and agreement about the care process changes desired, and little engagement of physicians.
CONCLUSION These findings highlight specific organizational challenges with health care transformation in the absence of a blueprint more specific than the CCM. Effective models of organizational change and detailed examples of proven, feasible care changes still need to be demonstrated if we are to transform care as called for by the Institute of Medicine.
Key Words: Chronic disease • models, theoretical • organizational innovation • physician’s practice patterns • quality of health care
This article has been cited by other articles:
|
|
 |
|
  A. Minnick, C. D. Catrambone, L. Halstead, S. Rothschild, and S. Lapidos A Nurse Coach Quality Improvement Intervention: Feasibility and Treatment Fidelity West J Nurs Res, October 1, 2008; 30(6): 690 - 703. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Cherrington, G. X. Ayala, H. Amick, J. Allison, G. Corbie-Smith, and I. Scarinci Implementing the Community Health Worker Model Within Diabetes Management: Challenges and Lessons Learned From Programs Across the United States The Diabetes Educator, September 1, 2008; 34(5): 824 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Sidorov The Patient-Centered Medical Home For Chronic Illness: Is It Ready For Prime Time? Health Aff., September 1, 2008; 27(5): 1231 - 1234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D A Ganz, G E Alkema, and S Wu It takes a village to prevent falls: reconceptualizing fall prevention and management for older adults Inj. Prev., August 1, 2008; 14(4): 266 - 271. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Russell, P. Thille, W. Hogg, and J. Lemelin Beyond Fighting Fires and Chasing Tails? Chronic Illness Care Plans in Ontario, Canada Ann. Fam. Med, March 1, 2008; 6(2): 146 - 153. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Zweifler The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office Ann. Fam. Med, September 1, 2007; 5(5): 453 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Feifer, L. Nemeth, P. J. Nietert, A. M. Wessell, R. G. Jenkins, L. Roylance, and S. M. Ornstein Different Paths to High-Quality Care: Three Archetypes of Top-Performing Practice Sites Ann. Fam. Med, May 1, 2007; 5(3): 233 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. I. Solberg Improving Medical Practice: A Conceptual Framework Ann. Fam. Med, May 1, 2007; 5(3): 251 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Stange On TRACK: 'Allows Readers and Authors to Go One Step Further' Ann. Fam. Med, September 1, 2006; 4(5): 463 - 464. [Full Text] [PDF]
|
|
|
|
|
|
K. C. Stange and R. S. Gotler In this Issue: Mixed Methods and Diverse Perspectives Ann. Fam. Med, July 1, 2006; 4(4): 290 - 291. [Full Text] [PDF]
|
|
|
|
|
|
K. C. Stange, B. F. Crabtree, and W. L. Miller Publishing Multimethod Research Ann. Fam. Med, July 1, 2006; 4(4): 292 - 294. [Full Text] [PDF]
|
|
|
|
|
|
L. I. Solberg, A. L. Crain, J. M. Sperl-Hillen, M. C. Hroscikoski, K. I. Engebretson, and P. J. O'Connor Care Quality and Implementation of the Chronic Care Model: A Quantitative Study Ann. Fam. Med, July 1, 2006; 4(4): 310 - 316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Annals Journal Club: Implementing the Chronic Care Model Ann. Fam. Med, July 1, 2006; 4(4): iii - iii. [Full Text] [PDF]
|
|
Read all TRACK Comments
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
