Disease management projects and the Chronic Care Model in action: baseline qualitative research

Abstract

BackgroundDisease management programs, especially those based on the Chronic Care Model (CCM), are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of five disease management programs in the primary care setting, based on interviews with project leadership teams.MethodsEleven semi-structured interviews were conducted at the five selected sites with sixteen professionals interviewed; all project directors and managers were interviewed. The interviews focused on each project’s chosen chronic illness (diabetes, eating disorders, COPD, multi-morbidity, CVRM) and project plan, barriers to development and implementation, the project leaders’ action and reactions, as well as their roles and responsibilities, and disease management strategies. Analysis was inductive and interpretive, based on the content of the interviews. After analysis, the results of this research on disease management programs and the Chronic Care Model are viewed from a traveling technology framework.ResultsThis analysis uncovered four themes that can be mapped to disease management and the Chronic Care Model: (1) changing the health care system, (2) patient-centered care, (3) technological systems and barriers, and (4) integrating projects into the larger system. Project leaders discussed the paths, both direct and indirect, for transforming the health care system to one that addresses chronic illness. Patient-centered care was highlighted as needed and a paradigm shift for many. Challenges with technological systems were pervasive. Project leaders managed the expenses of a traveling technology, including the social, financial, and administration involved.ConclusionsAt the sites, project leaders served as travel guides, assisting and overseeing the programs as they traveled from the global plans to local actions. Project leaders, while hypothetically in control of the programs, in fact shared control of the traveling of the programs with patients, clinicians, and outside consultants. From this work, we can learn what roadblocks and expenses occur while a technology travels, from a project leader’s point of view.

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

“…Intervention source B. Evidence strength & quality “Limited guidance on prepared practice team development” [ 40 ] C. Relative advantage “Patient screened by staff before seeing physician ” [ 39 ], “Structured assessment in patient education” [ 39 ] D. Adapability “Integrating Guided Care nurse in work flow” [ 36 ], “Processes integrated in to existing clinical operations” [ 43 ], “CCM adaption within context of daily practice” [ 48 ], “Program tailored to region needs” [ 50 ], “Adapting communication system to local context” [ 52 ], “Integrated project to routine care” [ 52 ] E. Trialability F. Complexity “Intervention was too complex, targeted different components resulting in many priorities” [ 50 ] G. Design quality & packaging “Nurse training for components of intervention” [ 35 ], “Curriculum should be specific to CCM intervention” [ 36 ], “Different intervention model options were offered” [ 19 ], “Structured learning sessions and support by health collaborative” [ 44 ], “Guideline development” [ 50 ] “Intervention was too disease specific and did not address chronic care principles” [ 45 ] H. Cost “Low-cost program relied on community health workers, mentors and non-clinical staff” [ 43 ], “Financially viable” [ 48 ], “Sufficient funding” [ 37 ] 2. Outer setting A.…”

“…Inner setting A. Structural characteristics “Development of prepared practice teams” [ 40 ], “Electronic medical record (EMR) implementation and clinic remodelling” [ 39 ], “Recruitment of multilingual staff and interpreters to address language barriers” [ 44 ], “Worked with human resources to change organizational policies” [ 44 ], “Role of specialist in supporting and supervising other staff” [ 45 ], “Addition of technology system” [ 52 ], “Nurse practitioner role in implementation” [ 53 ] “Staff turnover” [ 19 ], “Large size of medical group” [ 40 ], “Unions unsupportive of staff role change” [ 40 ], “Medical director turnover” [ 38 ], “Need to expand role of provider” [ 44 ], “Staff turnover and loss meant very few staff could assume additional responsibilities” [ 44 ], “Lack of staff expertise in team approach to implementation” [ 48 ], “Lack of flexibility in reorganizing model of care” [ 52 ], “Smaller organizations had difficulty addressing barriers” [ 45 ] C. Culture “Support from primary care physicians” [ 35 ], “Support from physicians” [ 36 ], “Recognition of benefit of care managers” [ 39 ], “Stable work relationships” [ 40 ], “Recognition of patient role in self management” [ 44 ], “Persistence despite extra work” [ 44 ], “Organizational culture and enthusiasm for care improvement” [ 45 ], “Promoting multidisciplinary approach” [ 51 ], “Change to patient-centred care” [ 52 ], “Receiving personal recognition” [ 37 ] “Providers need for clear structure and autonomy” [ 19 ], “Organizational culture unsupportive of change” [ 40 ], “Lack of commitment or tradition of working in interdisciplinary teams” [ 50 ], “Difficulty changing provider care to patient-centered care” [ 52 ], “Rigid role expectations and thought processes” [ 52 ] D. Implementation climate “Clear, shared long ...…”

Disease Management and the Patient's Role in This Process

“…Turkiye Klinikleri J Health Sci 2016;1 (3) In the focus groups has been clearly outlined the opinion that it is necessary to significantly improve basic health education. "...…”

“…In parallel, evidence is accumulated in the strategies for dealing with chronic diseases and challenges the effectiveness of existing approaches. [1][2][3][4] In recent years the so called Chronic Care Model has established itself. 5 The model created in the U.S. in the 90s of the last century by Edward Wagner, is widely used in many countries nowadays.…”

Interprofessional practice in primary care: development of a tailored process model

“…Client-centered care can be recognized in the CCM, through the Selfmanagement support domain 9. Mead and Bower10 identified five requirements for good client-centered care.…”