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Table 3 Overview of studies on the CCM in primary care

From: Facilitators and barriers of implementing the chronic care model in primary care: a systematic review

Reference/Location Study design, methods Participants (n)/ study setting Objective CCM Intervention
[34] Mexico Quantitative, pilot study, survey assessing chronic care delivery, and measurement of clinical outcome Primary care teams (n = 10): physicians, nurses and other professionals were randomly selected and assigned to intervention or control group Evaluate whether implementation of diabetes quality improvement (QI) project improved patient outcomes A, B, C, D, E, F Implementation of QI strategy for diabetes care based on three learning sessions, followed by Plan, Do, Study, Act (PDSA) practice
[35] USA Quantitative, pilot study Registered nurse, general internists and multi-morbid patients in an urban primary care practice Assess feasibility of implementing the Guided Care Model A, C, D, E, F Guided Care Nurse worked with two physicians to conduct geriatric evaluation, disease management and to coordinate care.
[36] [USA] Quantitative, nonrandomized-prospective clinical trial, survey measuring primary care experiences Older community patients (n = 150), Registered nurse, general internists (n = 4) in an urban primary care practice Evaluate intervention to enhance the quality of primary care experiences in chronically ill older persons based on Guided Care model A, C, D, E, F Guided Care Nurse provided geriatric assessment, a comprehensive care plan, proactive follow-up, coordination of care, and access to community resources
[19] [USA] Mixed methods study, triangulation of measured clinical processes and outcomes, provider surveys and semi-structured interviews Team leaders and members (n = 106) in 19 community health centres (CHC)s participating in diabetes QI collaborative Evaluate whether the Diabetes Health Disparities Collaborative can improve the quality of care in CHCs A, B, C, D, E, F CHCs formed QIs teams which attended collaborative learning sessions and adapted QI plans using the PDSA design
[37] USA Quantitative study, self-administered questionnaires on CHC staff Staff (n = 622) of CHCs (n = 145) participating in QI initiative Assess predictors of changes in staff morale and burnout at CHCs participating in Health Disparities Collaborative A, B, C, D, E, F CHCs participated in quarterly regional or national learning sessions and developed QI teams which utilized the PDSA model
[38] [USA] Quantitative, matched control study, organizational survey, and measurement of care process CHCs (n = 19) in Health Disparities Cancer Collaboratives, and controls (n = 22) in underserved population Assess whether CHCs in collaboratives were more likely to implement cancer care process changes A, B, C, D, E, F CHCs formed teams to learn how to implement change, facilitated by an expert faculty. Health centers reported and shared QI experiences during monthly teleconferences and three in-person learning sessions
[39] USA Qualitative study, semi-structured interviews, using grounded theory approach Primary care physicians (n = 24) in multi/single specialty groups or single practices Examine primary care physicians’ views on obstacles to providing depression care and CCM-based interventions A, B, C, D, E Depression screening, structured assessment, patient education, mental healthcare integration, consults and care management
[40] USA Qualitative study, semi-structured interviews, observational notes Leaders and front-line physicians and nurses (n = 53) in a large multispeciality health group (clinics, n = 5) Evaluate care changes and processes used to implement CCM A, B, C, D, E, F Project leaders and multidisciplinary teams were created to guide implementation, and individual care teams piloted the intervention
[41] USA Quantitative study Physicians (n = 17) and nurse practitioners (n = 5) in a metropolitan family practice clinic Describe steps to successfully implement clinic-in-a-clinic diabetes self-management that uses PDSA A, B, C, D, E, F Education, behaviour change support, goal setting and follow up provided by nurse practitioner to Type 2 diabetes patients who require more intensive counselling on diabetic self management issues
[42] USA Quantitative, quasi-experimental with concurrent non-randomized controls, measuring intermediate diabetes outcomes General internists, nurse practitioners, pharmD, clinical health psychologist and nurses in a primary care clinic in a tertiary care academic medical centre Evaluate intermediate outcome measures of diabetic patients in shared medical appointments (SMA) in comparison to control patients. A, B, C, D, E Utilised diabetes registry to identify target patients. Provided decision support by practice guidelines and by including a diabetes specialist in the team. Multidisciplinary team provided didactic group education and individual learning in shared medical appointments
[43] USA Quantitative study, measuring patient participation and changes in diabetes related outcomes Diabetic patients (n = 275) in a CHC serving low-income Latinos Assess patient engagement in self management activities and changes in glycosylated hemoglobin (HbA1c). B Implementation of diabetes education classes, chronic self-management classes, weekly drop-in sessions, individual counseling, daily exercise classes and bilingual services
[44] USA Qualitative study, structured interview based on ecological systems theory Team leaders and members of CHCs collaborative (n = 14) Identify strategies that contributed to CHCs’ successes and challenges in diabetes QI A, B, C, D, E, F CHCs assembled teams to participate in the collaborative. They were responsible for coordinating and reporting activities, and electronic registries. The CCM was implemented by a champion panel made of diabetic patients.
[45] USA Qualitative study, telephone interviews Managers, mental health specialists and care managers in health care organizations (n = 5) To understand the experiences of project participants in implementing depression improvement model. A, B, C, D, E Care management, an improved interface between mental health consultants and primary care clinicians, and preparation of primary care clinicians and practices to provide systematic depression management
[46] USA Quantitative study, measured fidelity to and intensity of CCM implementation Health care organizations (n = 42) part of QI collaboratives (n = 3) Measure organizations’ implementation of CCM interventions for chronic care QI A, B, C, D, E, F Health care organizations attended three learning sessions together to collaboratively improve performance and focus on implementing small rapid change cycles in their practices
[47] USA Quantitative study Community based primary care physicians’ offices. Evaluate the Assessing Care of Vulnerable Elderly Persons (ACOVE) intervention for adults with geriatric conditions A, B, C, D, E Case finding, collection of condition-specific clinical data, medical record prompts to encourage performance of essential care processes, patient education and activation, and physician decision support and education
[18] Canada Quantitative study, survey questionnaire evaluating physician normative practices consistent CCM Physicians (n = 195) in walk-in clinics (n = 29), solo family practices (n = 29), group family practices (n = 104), CHCs (n = 14) and primary care networks (n = 27) Examine implementation of CCM in different primary care practices A, B, C, D, E, F N/A
[48] USA Quantitative study Diabetic patients (n = 70) over 65 years old in a private medical clinic Determine whether patients in shared medical appointment meet the American Diabetes Association standards in diabetes self-management education A, C, D Implementation of a diabetes self management program using shared medical appointments
[49] USA Quantitative study, questionnaire measuring organization characteristics and care management processes Administrative leaders of physician organizations (n = 957), including medical groups (n = 621), independent practice associations (n = 336) across the US Examine the relationship between measures of primary care orientation and the implementation of the CCM A, B, C, D, F N/A
[50] Belgium Mixed methods study, CCM implementation survey, analysis of meeting reports General practitioner (n = 83), dietician (n = 1), pharmacist (n = 46), podiatrist (n = 5) and nurses (n = 90) providing care to type 2 diabetes patients (n = 2300) Assess degree of implementation of CCM, and facilitators and barriers encountered A, B, C, D, E, F Development and implementation of education program for patients on diet or oral therapy, establishment of a local steering group, appointment of program manager, provider education and regional audit
[51] Canada Qualitative study, structured interview with staff Health administrators, physician leaders, nurses and physicians (n = 12) in a large integrated academic institution. Examine strategies that promote physician involvement in planning and developing of heart failure care delivery A, B, C, D, E, F Detailed analysis of existing heart failure management strategies, a review of best practice strategies and potential future best direction for increased effectiveness
[52] Netherlands Qualitative study, semi-structured interview of project managers Project directors and managers (n = 16), in health care provider groups (n = 5) Understand the development, implementation and execution of disease management programs by project leaders and clinicians A, B, D, E Implementation of nation-wide disease management program in health organization in the Netherlands
[53] [USA] Qualitative, case study analysis using interviews Staff and patients from disease-specific shared medical appointments groups (N = 3) To describe the roles of nurse practitioners in shared medical appointment group visits A, B, C, D, E, F Implementation of nurse practitioners in shared medical appointments
  1. Quality improvement; QI, Chronic Care Model; CCM, Plan Do Study Act model; PDSA, Guided Care Nurse; GCN, Community Health Center; CHC; N/A; not available.
  2. CCM components.
  3. A = Delivery system redesign.
  4. B = Self management support.
  5. C = Decision support.
  6. D = Clinical information system.
  7. E = Health system organization.
  8. F = Community linkages.