The Article in Brief

Challenges of Change: Implementing the Chronic Care Model

Mary C. Hroscikoski, MD , and colleagues

Background Improving health care for people with chronic medical conditions is a major concern in the U.S. The Chronic Care Model (description below) suggests that care of the chronically ill should include prepared teams in the medical practice interacting with informed, involved patients. Although the Chronic Care Model (CCM) provides a well-developed framework for improving chronic medical care, there are no specific steps available to guide medical groups wanting to implement it. The purpose of this study is to examine and learn from the experience of a large medical group that implemented the CCM.

(Description: From: http://www.improvingchroniccare.org/change/model/components.html: “The Chronic Care Model identifies the essential elements of a health care system that encourage high-quality chronic disease care. These elements are the community, the health system, self-management support, delivery system design, decision support and clinical information systems. Evidence-based change concepts under each element, in combination, foster productive interactions between informed patients who take an active part in their care and providers with resources and expertise. The model can be applied to a variety of chronic illnesses, health care settings and target populations. The bottom line is healthier patients, more satisfied providers, and cost savings.”)

What This Study Found This medical group’s effort to transform its approach to care by implementing the CCM concepts appears to have produced some changes, in particular partial changes in the structure, roles, and function of medical teams and the introduction of an electronic medical record. Medical practices implementing the CCM should select care processes that have been well worked out in similar settings, or before tackling implementation, they should devote time to careful design and pilot testing. The CCM may be best suited as a backdrop for understanding the relationships and roles of specific care changes that are needed, rather than as a blueprint or training model for change.

Implications

• The team changes in this study were small and varied, but they may represent a first step in creating a new foundation for transformed care.
• Changing traditional care patterns is very difficult, requiring enormous attention and focus with clear specifications, strong leadership, and attention to many details at both local and central levels of an organization.