Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care

Abstract

BackgroundEfforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in the health care literature, but may be related to the ability of primary care practices to improve the care they deliver.To better understand learning in primary care settings by developing a scale of learning in primary care clinics based on the literature related to learning across disciplines, and to examine the association between scale responses and chronic care model implementation as measured by the Assessment of Chronic Illness Care (ACIC) scale.MethodsDevelopment of a scale of learning in primary care setting and administration of the learning and ACIC scales to primary care clinic members as part of the baseline assessment in the ABC Intervention Study. All clinic clinicians and staff in forty small primary care clinics in South Texas participated in the survey.ResultsWe developed a twenty-two item learning scale, and identified a five-item subscale measuring the construct of reciprocal learning (Cronbach alpha 0.79). Reciprocal learning was significantly associated with ACIC total and sub-scale scores, even after adjustment for clustering effects.ConclusionsReciprocal learning appears to be an important attribute of learning in primary care clinics, and its presence relates to the degree of chronic care model implementation. Interventions to improve reciprocal learning among clinic members may lead to improved care of patients with chronic disease and may be relevant to improving overall clinic performance.

Relationships within inpatient physician housestaff teams and their association with hospitalized patient outcomes

“…12 Research indicates that interactions among healthcare providers can have important influences on outcomes. [13][14][15][16][17] Additionally, the initial implementation of checklists to prevent central-line associated infections appeared to change provider relationships in a way that significantly influenced their success. 18 For example, positive primary care clinic member relationships as assessed by the Lanham framework have been associated with better chronic care model implementation, learning, and patient experience of care.…”

“…We used a purposeful sampling approach to obtain a diverse sample, sampling based on physician attributes and time of year. 16,17 Three characteristics were most important: attending physician years of experience, attending involvement in educational and administrative leadership, and the presence of struggling resident members, as defined by being on probation or having been discussed in the residency Clinical Competency Committee. We did not set explicit thresholds in terms of attending experience, but instead sought to ensure a range.…”

Technology and Care for Patients with Chronic Conditions: The Chronic Care Model as a Framework for the Integration of ICT

“…Community resources and policies are essential to facilitate the implementation of technology supported integrated care [27]. To implement integrated care according to CCM, new partnerships in the community with citizens, medical and social professionals have to be established.…”

Adaptación y validación de la versión chilena del cuestionario “Evaluación de la Atención de Enfermedades Crónicas para pacientes”

“…Es así como, la revisión de literatura revela una amplia evidencia de la utilización del modelo de cuidados crónicos 7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] y de la evaluación de los cuidados proporcionados a los usuarios con en-fermedad crónica utilizando como herramienta el cuestionario Patient Assessment of Chronic Illness Care (PACIC) [24][25][26][27][28][29][30][31][32][33][34][35][36] . Este instrumento proporciona una evaluación de la atención de enfermedades crónicas desde la perspectiva del paciente y, en particular, del apoyo al automanejo 24 .…”