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Features of the Chronic Care Model (CCM) Associated with Behavioral Counseling and Diabetes Care in Community Primary Care

Department of Biostatistics (PAOS), University of Medicine and Dentistry of New Jersey, School of Public Health, Piscataway
Department of Epidemiology (BFC), University of Medicine and Dentistry of New Jersey, School of Public Health, Piscataway
Department of Family Medicine (PAOS, SVH, AP, KH, DC, BFC), University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, New Brunswick, NJ
Cancer Institute of New Jersey (PAOS, SVH, BFC), University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, New Brunswick, NJ
Department of Family Medicine, Dartmouth, Concord, NH (AJO)
South Texas Veterans Health Care System, San Antonio, TX (MLP)
Center for Research in Family Practice and Primary Care, Cleveland, OH, (BFC)

Correspondence: Corresponding author: Pamela A. Ohman Strickland, PhD, Department of Biostatistics, UMDNJ-SPH, 683 Hoes Lane West, Room 218, P.O. Box 9, Piscataway, NJ 08854 (E-mail: ohmanpa{at}umdnj.edu)

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."

Key Words: Primary Health Care • Chronic Disease • Diabetes • Chronic Care Model

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