Challenges of Change: A Qualitative Study of Chronic Care Model Implementation
Ann Fam Med Hroscikoski et al.
4: 317
Annals Journal Club Selections:
Jul/Aug 2006
The Annals Journal Club is designed to encourage a learning community of those seeking
to improve health care and health through enhanced primary care. Additional information is
available on the Journal Club home page.
Articles for Discussion
Solberg LI, Crain AL, Sperl-Hillen JM, Hroscikoski MC, Engebretson KI, O’Connor PJ. Care
quality and implementation of the Chronic Care Model: a quantitative study. Ann Fam Med.
2006;4:310-316.
Hroscikoski MC, Solberg LI, Sperl-Hillen JM, Harper PG, McGrail M, Crabtree BF. The
challenges of change: implementing the Chronic Care Model. Ann Fam Med.
2006;4:317-326.
Discussion Tips
This issue of Annals features multimethod research that integrates both quantitative and
qualitative methods. These methods have complementary strengths and weaknesses, and their
conjoint use often can provide a fuller picture than studies using either type of method
alone.1 The intervention being evaluated in the articles for this journal
club is based on the Chronic Care Model.2 This theoretical framework is
being widely used to develop infrastructure to promote informed, activated patients interacting
with a prepared, proactive practice team to improve patients’ functional and clinical
outcomes.
Was the design of each study appropriate to its research question?
What designs and measures would be stronger?
What characteristics of the study practices and health care system are different from your
practice in ways that affect the transportability of the findings?
To what degree can the findings be accounted for by:
Inadequate sample size?
Selection bias in who was included in the study?
Poorly measured or irrelevant constructs?
Poor implementation of the model?
High baseline performance in the participating practices?
Changes not attributable to the intervention?
What are the strengths and weaknesses of the quantitative study (Solberg et al)? What are
the strengths and weaknesses of the qualitative study (Hroscikoski et al)? How do the strengths
of one bolster the weaknesses of the other?
What are some relative weakness in your practice’s ability to provide good chronic care
(see the elements of the Chronic Care Model in Solberg or Figure 1 in Hroscikoski)? What office
systems or other process changes would improve chronic care? Which changes would have the
greatest impact on quality of chronic care? Which changes would be easy to implement?
Given the lessons learned by the authors, what would be your strategy for making change in
your practice?
