The chronic care model and diabetes management in US primary care settings: a systematic review

Michael Stellefson, Krishna Dipnarine, Christine Stopka, Michael Stellefson, Krishna Dipnarine, Christine Stopka

Abstract

Introduction: The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation.

Methods: We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: "chronic care model" (and) "diabet*." We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies.

Results: The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP officd-based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies.

Conclusion: CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making.

Figures

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Manuscript selection for systematic review on the Chronic Care Model (CCM) and diabetes management in US primary care settings.

References

    1. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. . Accessed June 12, 2012.
    1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. . Accessed June 12, 2012.
    1. Centers for Disease Control and Prevention. Chronic diseases and health promotion. National Center for Chronic Disease Prevention and Health Promotion; 2010. . Accessed June 12, 2012.
    1. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001;20(6):64–78. 10.1377/hlthaff.20.6.64
    1. Wagner EH, Davis C, Schaefer J, Von Korff M, Austin B. A survey of leading chronic disease management programs: are they consistent with the literature? Manag Care Q 1999;7(3):56–66.
    1. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288(14):1775–9. 10.1001/jama.288.14.1775
    1. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, et al. The expanded chronic care model: an integration of concepts and strategies from population health promotion and the chronic care model. Hosp Q 2003;7(1):73–82.
    1. Centre for Reviews and Dissemination. Systematic reviews: CRD’s guidance for undertaking reviews in health care. Layerthorpe, York (UK): York Publishing Services Ltd; 2009.
    1. MacLean CD, Littenburg B, Gagnon M, Reardon M, Turner PD, Jordan C. The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices. Clin Trials 2004;1(6):532–44. 10.1191/1740774504cn051oa
    1. Siminerio LM, Piatt G, Zgibor JC. Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice. Diabetes Educ 2005;31(2):225–34. 10.1177/0145721705275325
    1. Piatt GA, Orchard TJ, Emerson S, Simmons D, Songer TJ, Brooks MM, et al. Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention. Diabetes Care 2006;29(4):811–7. 10.2337/diacare.29.04.06.dc05-1785
    1. Siminerio LM, Piatt GA, Emerson S, Ruppert K, Saul M, Solano F, et al. Deploying the chronic care model to implement and sustain diabetes self-management training programs. Diabetes Educ 2006;32(2):253–60. 10.1177/0145721706287156
    1. Smith SA, Shah ND, Bryant SC, Christianson TJ, Bjornsen SS, Giesler PD, et al. Chronic care model and shared care in diabetes: randomized trial of an electronic decision support system. Mayo Clin Proc 2008;83(7):747–57. 10.4065/83.7.747
    1. Stuckey HL, Dellasega C, Graber NJ, Mauger DT, Lendel I, Gabbay RA. Diabetes nurse case manager and motivational interviewing for change (DYNAMIC): Study design and baseline characteristics in the chronic care model for type 2 diabetes. Contemp Clin Trials 2009;30(4):366–74. 10.1016/j.cct.2009.03.002
    1. Schillinger D, Handley M, Wang F, Hammer H. Effects of self-management support on structure, process, and outcomes among vulnerable patients with diabetes: a three-arm practical clinical trial. Diabetes Care 2009;32(4):559–66. 10.2337/dc08-0787
    1. Piatt GA, Anderson RM, Brooks MM, Songer T, Siminerio LM, Korytkowski MM, et al. 3-year follow-up of clinical and behavioral improvements following a multifaceted diabetes care intervention: results of a randomized controlled trial. Diabetes Educ 2010;36(2):301–9. 10.1177/0145721710361388
    1. Piatt GA, Songer TJ, Brooks MM, Anderson RM, Simmons D, Orchard TJ, et al. Impact of patient level factors on the improvement of the ABCs of diabetes. Patient Educ Couns 2011;82(2):266–70. 10.1016/j.pec.2010.04.005
    1. Stroebel RJ, Gloor B, Freytag S, Riegert-Johnson D, Smith SA, Huschka T, et al. Adapting the chronic care model to treat chronic illness at a free medical clinic. J Health Care Poor Underserved 2005;16(2):286–96. 10.1353/hpu.2005.0041
    1. Khan MA, Evans AT, Shah S. Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care. J Eval Clin Pract 2010;16(4):700–6. 10.1111/j.1365-2753.2009.01178.x
    1. Benedetti R, Flock B, Pedersen S, Ahern M. Improved clinical outcomes for fee-for-service physician practices participating in a diabetes care collaborative. Jt Comm J Qual Saf 2004;30(4):187–94.
    1. Coca A, Francis MD. Implementing the chronic care model in an academic setting: a resident’s perspective. Sem Med Pract 2007;10(1):1–8.
    1. Caruso LB, Clough-Gorr KM, Silliman RA. Improving quality of care for urban older people with diabetes mellitus and cardiovascular disease. J Am Geriatr Soc 2007;55(10):1656–62. 10.1111/j.1532-5415.2007.01320.x
    1. Lyles CR, Harris LT, Le T, Flowers J, Tufano J, Britt D, et al. Qualitative evaluation of a mobile phone and web-based collaborative care intervention for patients with type 2 diabetes. Diabetes Technol Ther 2011;13(5):563–9. 10.1089/dia.2010.0200
    1. Liebman J, Heffernan D, Sarvela P. Establishing diabetes self-management in a community health center serving low-income Latinos. Diabetes Educ 2007;33(Suppl 6):132S–8S. 10.1177/0145721707304075
    1. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2012;35(Suppl 1):S11–63.10.2337/dc12-s011
    1. Simmons D, Weblemoe T, Voyle J, Prichard A, Leakehe L, Gatland B. Personal barriers to diabetes care: lessons from a multi-ethnic community in New Zealand. Diabet Med 1998;15(11):958–64. 10.1002/(SICI)1096-9136(1998110)15:11<958::AID-DIA687>;2-9
    1. Tsai AC, Morton SC, Mangione CM, Keeler EB. A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care 2005;11(8):478–88.
    1. Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, et al. National standards for self-management education. Diabetes Care 2009;32(Suppl 1):S87–94. 10.2337/dc09-S087
    1. Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev 2007;64(5 Suppl):101S–56S. 10.1177/1077558707305409
    1. Centers for Disease Control and Prevention. Groups especially affected. Diabetes Public Health Resource; 2012. . Accessed October 7, 2012.
    1. Stellefson ML, Hanik BW, Chaney BH, Chaney JD. Challenges for tailored messaging in health education. Am J Health Educ 2008;39(5):303–11.
    1. Centers for Disease Control and Prevention. Children and diabetes — more information. Diabetes Public Health Resource; 2012. . Accessed October 7, 2012.
    1. Rapley P, Davidson PM. Enough of the problem: a review of time for health care transition solutions for young adults with a chronic illness. J Clin Nurs 2010;19(3-4):313–23. 10.1111/j.1365-2702.2009.03027.x
    1. Stellefson M, Chaney B, Chaney D. The digital divide in health education: myth or reality? Am J Health Educ 2008;39(2):106–12.
    1. Stellefson M, Chaney BH, Chaney JD. Using exploratory focus groups to inform the development of targeted COPD self-management education DVDs for rural patients. Int J Telemed Appl 2010;2010:450418.
    1. Hall AK, Stellefson M, Bernhardt JM. Healthy Aging 2.0: the potential of new media and technology. Prev Chronic Dis 2012;9:E67.
    1. Epping-Jordan J, editor. Innovative care for chronic conditions: building blocks for action: global report (document no. WHO/NMC/CCH/0201). World Health Organization; 2002.

Source: PubMed

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