Features of the Chronic Care Model (CCM) associated with behavioral counseling and diabetes care in community primary care.
BACKGROUND
The Chronic Care Model (CCM) was developed to improve chronic disease care, but it may also inform delivery of other types of preventive care. Using hierarchical analyses of service delivery to patients, we explored associations of CCM implementation with diabetes care and counseling for diet or weight loss and physical activity in community-based primary care offices.


METHODS
Secondary analysis focused on baseline data from 25 practices (with an average of 4 physicians per practice) participating in an intervention trial targeting improved colorectal cancer screening rates. This intervention made no reference to the CCM. CCM implementation was measured through staff and clinical management surveys and was associated with patient care indicators (chart audits and patient questionnaires).


RESULTS
Overall, practices had low levels of CCM implementation. However, higher levels of CCM implementation were associated with better diabetes assessment and treatment of patients (P = .009 and .015, respectively), particularly among practices open to "innovation." Physical activity counseling for obese and, particularly, overweight patients was strongly associated with CCM implementation (P = .0017), particularly among practices open to "innovation"; however, this association did not hold for overweight and obese patients with diabetes.


CONCLUSIONS
Very modest levels of CCM implementation in unsupported primary care practices are associated with improved care for patients with diabetes and higher rates of behavioral counseling. Incremental incorporation of CCM components is an option, especially for community practices with stretched resources and with cultures of "innovativeness."
Strickland
Pamela A Ohman
PA
Department of Biostatistics, University of Medicine and Dentistry of New Jersey, School of Public Health, Piscataway. ohmanpa@umdnj.edu
Hudson
Shawna V
SV
Piasecki
Alicja
A
Hahn
Karissa
K
Cohen
Deborah
D
Orzano
A John
AJ
Parchman
Michael L
ML
Crabtree
Benjamin F
BF
D000368:Aged; D001521:Behavior Therapy; D002908:Chronic Disease; D003153:Community Health Services; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000178:diet therapy / Q000517:prevention & control*; D004032:Diet; D037001:Directive Counseling; D019468:Disease Management; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009043:Motor Activity; D009765:Obesity / Q000178:diet therapy / Q000517:prevention & control*; D016017:Odds Ratio; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D015431:Weight Loss
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