Organizational Traits and QI

Schmittdiel JA, Shortell SM, Rundall TG, Bodenheimer T, Selby JV. Effect of primary health care orientation on chronic care management. Ann Fam Med 2006; 4(2):117-23. [Link]
There is a significant relationship between a practice’s primary care orientation and its implementation of the CCM. Specifically, medical groups (as opposed to IPAs) that accept risk for hospitalization costs, use health promotion programs, have an electronic standardized problem list, and are required to report patient process and outcome measures appear to use more chronic care management practices.

Fleming B, Silver A, Ocepek-Welikson K, Keller D. The relationship between organizational systems and clinical quality in diabetes care. Am J Manag Care 2004; 10(12):934-44. [Link]
Flemming et al. studied 134 managed Medicare organizations and collected diabetes quality measures (HbA1c, LDL, microalbuminuria and eye exams). They assessed 32 care elements based on the CCM and compared top and bottom quartiles on quality (e.g., HbA1c > 9.5–20% vs. 50%). Top quartile more likely to employ CCM elements, especially: computerized reminders, practitioner involvement on QI teams, guidelines supported by academic detailing, formal self-management programs, a registry.

Hung DY, Rundall TG, Crabtree BF, Tallia AF, Cohen DJ, Halpin HA. Influence of primary care practice and provider attributes on preventive service delivery. Am J Prev Med 2006; 30(5):413-22. [Link]
Staff participation in practice decisions and optimization of the clinical care team to include non-physician staff can improve the delivery of preventive services. In addition, improved clinical systems such as reminders and patient registries are associated with improved delivery of preventive services.

Li R, Simon J, Bodenheimer T, et al. Organizational factors affecting the adoption of diabetes care management processes in physician organizations. Diabetes Care 2004; 27(10):2312-6. [Link]
Overall, physician organizations have not adopted as many components of the diabetes care management index as we would expect. 47% use one or fewer care management processes. A number of factors were associated with increased use of care management processes: Reporting data to external organizations; receiving income, recognition, or better contracts for quality; improved IT infrastructure; ownership by HMO or hospital system; receiving capitated payments; and large size.
Lieu TA, Finkelstein JA, Lozano P, et al. Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children. Pediatrics 2004; 114(1):e102-10. [Link]

Use of reports to physicians were associated with better medication prescription practices, parent ratings of care, and asthma physical status among Medicaid-insured, asthmatic children.
Jackson GL, Yano EM, Edelman D, et al. Veterans Affairs primary care organizational characteristics associated with better diabetes control. Am J Manag Care 2005; 11(4):225-37. [Link]

In the VA, programs with improved HbA1c results utilize computerized diabetes reminders, engage patients, and involve physicians in quality improvement.
Mangione CM, Gerzoff RB, Williamson DF, et al. The association between quality of care and the intensity of diabetes disease management programs. Ann Intern Med 2006; 145(2):107-16. [Link]
 Use of physician reminders, performance feedback, and structured care management were all associated with improved diabetes process, but not improved outcomes.
O’Connor PJ, Sperl-Hillen JM, Pronk NP, Murray T. Primary Care Clinic-Based Chronic Disease Care - Features of Successful Programs. Disease Management & Health Outcomes 2001; 9( 12):691-8. [Link N/A]
Top performing practices utilize combinations of 10 key strategies to improve care: leadership, resources, clinical guideline, organized care teams, patient activation, information systems, identification of population at risk, monitoring, prioritization, and active outreach to patients.
Sperl-Hillen JM, Solberg LI, Hroscikoski MC, Crain AL, Engebretson KI, O'Connor PJ. Do all components of the chronic care model contribute equally to quality improvement? Jt Comm J Qual Saf 2004; 30(6):303-9. [Link]
Leader’s responses to a survey assessing the presence of CCM components in their practices were partially correlated to improvements in HbA1c and LDL testing rates and outcomes. Delivery system design scores indicate that improvement in this area may be associated to improvements in process and outcome measures for diabetes.
Nutting PA, Dickinson WP, Dickinson LM, Nelson CC, King DK, Crabtree BF, Glasgow RE. Use of Chronic Care Model Elements Is Associated with Higher-Quality Care. Annals of Family Medicine 2007; 5(1):14-20. [Link]

Clinician’s responses to a survey assessing their use of CCM components was significantly correlated to improvements in HbA1c values and ratios of total cholesterol to HDL cholesterol. Clinician’s responses were also associated with the behavioral composite score and clinical care composite score--patient reported measures of improved care processes.

Bibliography Editor

Katie Coleman, M.S.P.H.

Katie Coleman is a research associate with the MacColl Institute and the most recent addition to the ICIC team.  Prior to joining ICIC, she managed a portfolio of government grants for the nation’s largest network of community health centers.  Her research interests include healthcare financing, pay for performance, and access to care including Medicaid and FQHC policy.