Table 3 Overview of studies on the CCM in primary care
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 |