Translating the Chronic Care Model Into the Community

Abstract

OBJECTIVE -To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes. RESEARCH DESIGN AND METHODS-This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n ϭ 30 patients), provider education only (PROV group) (n ϭ 38), and usual care (UC group) (n ϭ 51).RESULTS -A marked decline in HbA 1c was observed in the CCM group (Ϫ0.6%, P ϭ 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P ϭ 0.01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: Ϫ10.4 mg/dl, P ϭ 0.24; self-monitor blood glucose: ϩ22.2%, P Ͻ 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P ϭ 0.05; self-monitor blood glucose: P ϭ 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (ϩ5.5 mg/dl, P ϭ 0.0004), diabetes knowledge test scores (ϩ6.7%, P ϭ 0.07), and empowerment scores (ϩ2, P ϭ 0.02).CONCLUSIONS -These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes. Diabetes Care 29:811-817, 2006D iabetes affects ϳ7% of the U.S. population and has reached epidemic proportions (1). Diabetes represents a significant public health burden worldwide by decreasing quality of life and causing death and disability at great economic cost (2). Though quality diabetes care is essential to prevent long-term complications, care often falls below recommended standards regardless of health care setting or patient population, emphasizing the necessity for system change (3-6).The chronic care model (CCM) (3,4,7,8) is a multifaceted framework for enhancing health care delivery. The model is based on a paradigm shift from the current model of dealing with acute care issues to a system that is prevention based (3,5,(7)(8)(9). The premise of the model is that quality diabetes care is not delivered in isolation and can be enhanced by community resources, selfmanagement support, delivery system redesign, decision support, clinical information systems, and organizational support working in tandem to enhance patient-provider interactions (3,4,7-13). Currently, few efforts exist to implement multifaceted approaches to improve quality of care in diabetes despite studies that demonstrate their proven effectiveness (3,4,11,14,15).The objective of the current study was to determine the effectiveness of an intervention based on the CCM in primary care settings. We hypothesized that patient clinical (glycemic, blood pressure, and lipid control), behavioral (selfmonitoring of blood glucose), psychological/psychosocial (qualit...

2017 National Standards for Diabetes Self-Management Education and Support

“…The curriculum must be dynamic (5,97,(111)(112)(113). Recent education research endorses the inclusion of practical problem-solving approaches and collaborative care, addressing psychosocial issues, behavior change, and strategies to sustain self-management efforts (40, [114][115][116][117][118][119][120].…”

The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

“…The Chronic Care Model highlights the importance of a population-based approach; involving community, patients and providers; and information technology [4][5][6] . Various combinations of population management, practice support, and patient outreach have been used for diabetes care in a variety of settings with mixed results [7][8][9][10][11][12][13][14][15][16] . Many practice interventions for diabetes have been carried out in academic and urban centers.…”

Diabetes Management in Correctional Institutions

“…Generally, the literature favors current practice that utilizes the registered nurse, registered dietitian, and the registered pharmacist as the key primary instructors for diabetes education and members of the multidisciplinary team responsible for designing the curriculum and assisting in the delivery of DSME (1–7,77). In addition to registered nurses, registered dietitians, and pharmacists, a number of studies reflect the ever-changing and evolving health care environment and include other health professionals (e.g., a physician, behaviorist, exercise physiologist, ophthalmologist, optometrist, podiatrist) (48,80–84) and, more recently, lay health and community workers (85–91) and peers (92) to provide information, behavioral support, and links with the health care system as part of DSME.…”