Statewide evaluation of measuring physician delivery of self-management support in chronic disease care.
BACKGROUND
Self-management support is an important component of improving chronic care delivery.


OBJECTIVE
To validate a new measure of self-management support and to characterize performance, including comparisons across chronic conditions.


METHODS
We incorporated a new question module for self-management support within an existing annual statewide patient survey process in 2007.


METHODS
The survey identified 80,597 patients with a chronic illness on whom the new measure could be evaluated and compared with patients' experiences on four existing measures (quality of clinical interactions, coordination of care, organizational access, and office staff). We calculated Spearman correlation coefficients for self-management support scores for individual chronic conditions within each medical group. We fit multivariable logistic regression models to identify predictors of more favorable performance on self-management support.


RESULTS
Composite scores of patient care experiences, including quality of clinical interactions (89.2), coordination of care (77.6), organizational access (76.3), and office staff (85.8) were higher than for the self-management support composite score (69.9). Self-management support scores were highest for patients with cancer (73.0) and lowest for patients with hypertension (67.5). The minimum sample size required for medical groups to provide a reliable estimate of self-management support was 199. There was no consistent correlation between self-management support scores for individual chronic conditions within medical groups. Increased involvement of additional members of the healthcare team was associated with higher self-management support scores across all chronic conditions.


CONCLUSIONS
Measurement of self-management support is feasible and can identify gaps in care not currently included in standard measures of patient care experiences.
Sequist
Thomas D
TD
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. tsequist@partners.org
von Glahn
Ted
T
Li
Angela
A
Rogers
William H
WH
Safran
Dana Gelb
DG
D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards; D010819:Physician's Role; D015397:Program Evaluation / Q000379:methods / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D012648:Self Care / Q000379:methods / Q000592:standards*