What are the facilitators and barriers in physician organizations' use of care management processes?
BACKGROUND
Care management processes (CMPs) such as disease registries, reminder systems, performance feedback, case management, and self-management education can improve chronic illness care, yet 50% of physician organizations have instituted few if any CMPs.


METHODS
Site-visit interviews were conducted with 158 leaders at 15 physician organizations, with 3 organizations (1 large medical group, 1 small medical group, and 1 independent practice association [IPA]) chosen randomly in most cases in each of five communities.


RESULTS
Seven of the 15 organizations had implemented CMPs minimally or not at all. CMPs were most common for diabetes and least common for depression; no IPAs had achieved significant CMP implementation for any of the conditions. The two most commonly mentioned facilitators were strong leadership and organizational culture valuing quality. The top five barriers were poor financial situation, reimbursement that does not reward high quality, inadequate information technology, physician resistance, and physicians being too busy.


CONCLUSIONS
Strong leadership and a quality-valuing culture are important facilitators of improved chronic care, but if insurers do not reward chronic care improvement, it is unlikely that CMPs will become permanently institutionalized in physician organizations.
Department of Family and Community Medicine, University of California at San Francisco, USA. Tbodenheimer@MedSch.ucsf.edu
Thomas
T
Bodenheimer
Margaret C
MC
Wang
Thomas G
TG
Rundall
Stephen M
SM
Shortell
Robin R
RR
Gillies
Nancy
N
Oswald
Lawrence
L
Casalino
James C
JC
Robinson
D001249:Asthma / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy*; D003863:Depression / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D019468:Disease Management; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007193:Independent Practice Associations / Q000458:organization & administration; D007407:Interviews as Topic; D008329:Managed Care Programs / Q000458:organization & administration*; D010816:Physician Incentive Plans / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D014481:United States