Chronic Disease

Use of a chronic care model framework in primary care practices can influence patient health status

The chronic care model (CCM) is a comprehensive framework that can guide improvements in quality of health care. Most CCM research has centered on well-known illnesses, such as diabetes, hypertension, and asthma. A new research study, however, points to adapting the CCM as a counseling and prevention tool to improve patient health status in primary care practices.

The researchers examined data from 57 primary care practice-based research networks who implemented the CCM. The relationship between the CCM and three health measures—general health status, unhealthy days, and activity-limiting days—were examined.

General health status was found to vary significantly across CCM elements such as organization of care, self-management support for behavior change, delivery system design, integration of decision support, use of clinical information systems, and community resources. Significant relationships were identified for almost all CCM components and both unhealthy and activity-limiting days. Patients who received care from practices that supported behavior change were nearly twice as likely to have better health status than patients in practices that were hospital/university health system-owned, used group/individual planned visits for prevention, or PDAs for clinician-decision support. Practices that used patient registries, health promotion champions, and evidence-based guidelines for treating risk behaviors had patients with fewer unhealthy or activity-limiting days compared with practices that used group/individual planned visits for prevention and patient reminder cards.

These findings reinforce the idea that organizational characteristics can influence patient health outcomes, according to the researchers. The study was supported in part by the Agency for Healthcare Research and Quality (HS17007).

See "The chronic care model and relationships to patient health status and health-related quality of life," by Dorothy Y. Hung, Ph.D., M.P.H., Russell E. Glasgow, Ph.D., L. Miriam Dickinson, Ph.D., and others, in the November 2008 American Journal of Preventive Medicine 35(5S), pp. S398-S406.

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