title: Information system support as a critical success factor for chronic disease management: Necessary but not sufficient.
abstract: Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging.
  
  
  OBJECTIVE
  To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice.
  
  
  METHODS
  A prospective case study of positive deviants using key informant interviews, process observation, and document review.
  
  
  METHODS
  A chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet.
  
  
  METHODS
  Thirty community-based physician participants using predominantly paper records, plus a project management team including the physician lead, project manager, evaluator and support team.
  
  
  METHODS
  A critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice.
  
  
  RESULTS
  A web-based CDM 'toolkit' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology 'factor' was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation.
  
  
  CONCLUSIONS
  In complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.
authors.affiliation: School of Health Information Science, University of Victoria, Victoria, BC, Canada. carolyngreen@shaw.ca
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Green
authors.forename: Patricia
authors.initials: P
authors.lastname: Fortin
authors.forename: Malcolm
authors.initials: M
authors.lastname: Maclure
authors.forename: Art
authors.initials: A
authors.lastname: Macgregor
authors.forename: Sylvia
authors.initials: S
authors.lastname: Robinson
mesh_terms: D001955:British Columbia; D002908:Chronic Disease; D003299:Cooperative Behavior; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D003663:Decision Trees; D003695:Delivery of Health Care / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy*; D019317:Evidence-Based Medicine; D005163:Factor Analysis, Statistical; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D020407:Internet; D016347:Medical Records Systems, Computerized; D017146:Models, Organizational; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D018511:Systems Integration