The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams.
BACKGROUND
Recent research from a complexity theory perspective suggests that implementation of complex models of care, such as the Chronic Care Model (CCM), requires strong relationships and learning capacities among primary care teams.


OBJECTIVE
Our primary aim was to assess the extent to which practice member perceptions of relational coordination and reciprocal learning were associated with the presence of CCM elements in community-based primary care practices.


METHODS
We used baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM and improve risk factor control for patients with Type 2 diabetes in small primary care practices. Practice members (i.e., physicians, nonphysician providers, and staff) completed baseline assessments, which included the Relational Coordination Scale, Reciprocal Learning Scale, and the Assessment of Chronic Illness Care (ACIC) survey, along with items assessing individual and clinic characteristics. To assess the association between Relational Coordination, Reciprocal Learning, and ACIC, we used a series of hierarchical linear regression models accounting for clustering of individual practice members within clinics and controlling for individual- and practice-level characteristics and tested for mediation effects.


RESULTS
A total of 283 practice members from 39 clinics completed baseline measures. Relational Coordination scores were significantly and positively associated with ACIC scores (Model 1). When Reciprocal Learning was added, Relational Coordination remained a significant yet notably attenuated predictor of ACIC (Model 2). The mediation effect was significant (z = 9.3, p < .01); 24% of the association between Relational Coordination and ACIC scores was explained by Reciprocal Learning. Of the individual- and practice-level covariates included in Model 3, only the presence of an electronic medical record was significant; Relational Coordination and Reciprocal Learning remained significant independent predictors of ACIC.


CONCLUSIONS
Efforts to implement complex models of care should incorporate strategies to strengthen relational coordination and reciprocal learning among team members.
Research Psychologist, South Texas Veterans Health Care System, San Antonio, TX, USA. noelp@uthscsa.edu
Polly Hitchcock
PH
Noël
Holly J
HJ
Lanham
Ray F
RF
Palmer
Luci K
LK
Leykum
Michael L
ML
Parchman
D002908:Chronic Disease / Q000628:therapy*; D002983:Clinical Competence; D016000:Cluster Analysis; D003153:Community Health Services; D003299:Cooperative Behavior; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005194:Family Practice / Q000193:education* / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007400:Interprofessional Relations; D016014:Linear Models; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods*; D018794:Problem-Based Learning; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013781:Texas; D000078329:Workforce