Article Figures & Data
Tables
Term Definition Average Practice Score (SD) Descriptive Items Practice organization An organization that provides safe, high-quality care with leadership that encourages efforts to improve care 0.04 (1.00) Behavioral change support Effective behavior change support is used to help patients and families improve their health behavior 0.00 (0.43) Use of patient questionnaire at either the first visit or routine visits to identify patients who may benefit from counseling for eating habits, physical activity, smoking, alcohol use and cancer screening (maximum across first and routine-use responses and then averaged across behavior categories).‡
Refer out for counseling or screening (averaged across behavior categories).‡
Use nurses or health educators within the practice for individual counseling or use group counseling activities (averaged across behavior categories).‡
Frequency with which practices use a process or system for reminding patients about visits.§
Delivery system design Organizational features of the practice assure well-planned visits and impact the provision of care 0.00 (0.46) Decision support Clinicians have convenient access to the latest evidence-based guidelines and specialist expertise is integrated into the practice 0.04 (0.57) Clinical information systems Data about patients is organized to facilitate efficient and effective care 0.01 (0.77) * Average component scores were created as an average of z-scores from items used to assess each component.
† Practice Staff Questionnaire (PSQ), each item scored on a 1 to 5 scale, “strongly disagree” to “strongly agree.”
‡ PSQ, each item scored on a 1 to 5 scale, “never used” to “always used.”
§ Clinical Management Survey (CMS), scored on a 1 to 5 scale, “never used” to “always used.”
‖ CMS, scored on a 1 to 5 scale, “weekly,” “monthly,” “quarterly,” “annually,” “never.”
¶ CMS, a count of the types of staff in attendance: physicians, other clinicians, nursing staff, office staff.
** Patient survey, scored 1 to 5, “never” to “always.”
†† PSQ, 0 or 1 for “not used” or “used.”
PDA, personal digital assistant.
- Table 2.
Characteristics of the Combined Sample of 674 Patients Sampled Across 25 SCOPE Practices, Along with Summaries of Subpopulations of Patients Within Each Weight Category as Well as of Patients with Diabetes (Regardless of Weight Status)
Patient Characteristic Overall (n = 674) Normal (n = 183) Overweight (n = 218) Obese (n = 273) Diabetic (n = 196) Age* 64.1 (10.1) 64.21 (11.5) 66.0 (10.3) 62.5 (8.6) 64.9 (10.0) Sex (male) 267 (39.6) 58 (31.7) 108 (49.5) 101 (37.0) 89 (45.4) Race White 471 (69.9) 142 (77.6) 148 (67.9) 181 (66.3) 105 (53.6) Black 121 (18.0) 18 (9.8) 40 (18.4) 63 (23.1) 59 (30.1) Hispanic 46 (6.8) 6 (3.3) 22 (10.1) 18 (6.6) 16 (8.2) Other 32 (4.8) 16 (8.7) 6 (2.8) 10 (3.7) 12 (6.1) Unknown 4 (0.6) 1 (0.6) 2 (0.9) 1 (0.4) 4 (2.0) Education <High school 72 (10.7) 14 (7.7) 22 (10.1) 36 (13.2) 33 (16.8) High school or some college 326 (48.4) 71 (38.8) 106 (48.6) 149 (54.6) 101 (51.5) College or graduate school 273 (40.5) 97 (53.0) 90 (41.3) 86 (31.5) 60 (30.6) Unknown 3 (0.5) 1 (0.6) 0 (0) 2 (0.7) 2 (1.0) Marital status Married 424 (62.9) 114 (62.3) 150 (68.8) 160 (58.6) 111 (56.6) Not married 250 (37.1) 69 (37.7) 68 (31.2) 113 (41.4) 85 (43.4) Insurance status Medicare 257 (38.1) 68 (37.2) 88 (40.4) 101 (37.0) 84 (42.9) Medicaid 33 (4.9) 5 (2.7) 11 (5.1) 17 (6.2) 13 (6.6) Private 317 (47.0) 97 (53.0) 99 (45.4) 121 (44.3) 74 (37.8) Other 30 (4.5) 7 (3.83.0) 9 (4.1) 14 (5.1) 7 (3.6) None 29 (4.3) 4 (2.2) 10 (4.6) 15 (5.5) 18 (9.2) Unknown 8 (1.2) 2 (1.1) 1 (0.5) 5 (1.8) 0 (0) Global health* 2.29 (0.61) 2.16 (0.62) 2.26 (0.64) 2.41 (0.55) 2.54 (0.54) Physical health* 2.34 (0.63) 2.16 (0.66) 2.30 (0.64) 2.50 (0.57) 2.65 (0.54) Emotional health* 2.14 (0.66) 2.11 (0.61) 2.06 (0.69) 2.22 (0.66) 2.30 (0.67) Visits during past 2 years (n)* 7.57 (5.29) 6.64 (4.62) 7.42 (4.77) 8.32 (5.97) 8.73 (5.94) Diabetes assessment – – – – 91 (46.4) Diabetes treatment – – – – 99 (50.5) At least 2 out of 3 diabetes outcomes at target – – – – 84 (42.9) Received diet or weight loss counseling – – 118 (53.4) 212 (77.7) 137 (69.90) Received physical activity counseling – – 127 (57.5) 191 (70.0) 137 (69.90) Data presented as n (%) unless otherwise indicated.
* Data presented as mean (SD).
–, these n (%) are not provided as these services or targets are not recommended per guidelines for these groups of patients.
- Table 3.
Hypothesis 1: Odds Ratios and Confidence Intervals Describing the Relationship between Chronic Care Model Implementation, as a Whole and as Subcomponents, and Diabetes Care and Behavioral Counseling for Overweight/Obese Patients*
Patient Services Comprehensive CCM Implementation (odds ratio [CI]) CCM Implementation by Component (odds ratio [CI]) Decision Support Clinical Information Systems Practice Organization (Openness to innovation) Behavioral Change Support Delivery Systems Patients with diabetes (n = 196) Assessment* (y = 91) 1.90 (1.17–3.08) 1.06 (0.28–4.01) 1.42 (0.85–2.36) 1.73 (0.91–3.28) 1.15 (0.47–2.78) 0.89 (0.59–1.34) Treatment† (y = 99) 1.79 (1.12–2.86) 0.90 (0.18–4.45) 1.33 (0.77–2.30) 1.41 (0.74–2.68) 1.47 (0.53–4.04) 1.0045 (0.55–1.83) Targets (at least 2 out of 3)‡ (y = 84) 1.20 (0.86–1.67) 0.78 (0.19–3.36) 1.55 (1.04–2.29) 1.044 (0.66–1.65) 1.06 (0.57–1.97) 0.99 (0.74–1.34) Diet or weight-loss counseling (y = 137) 1.03 (0.63–1.70) 1.44 (0.63–3.30) 0.92 (0.71–1.19) 0.79 (0.47–1.31) 0.91 (0.51–1.63) 1.58 (1.12–2.23) Physical activity counseling (y = 137) 0.95 (0.82–1.09) 0.60 (0.26–1.39) 1.16 (0.78–1.72) 0.82 (0.62–1.09) 1.06 (0.76–1.48) 1.22 (0.92–1.64) Obese or overweight patients (with or without diabetes; n = 491) Diet or weight loss counseling (y = 330) 1.09 (0.92–1.28) 1.20 (0.69–2.08) 1.03 (0.77–1.38) 0.96 (0.77–1.20) 0.9975 (0.74–1.34) 1.06 (0.81–1.39) Physical activity counseling (y = 318) 1.35 (1.12–1.63) 0.89 (0.51–1.54) 1.18 (0.87–1.59) 1.14 (0.94–1.39) 1.34 (1.06–1.69) 1.13 (0.89–1.45) Obese or overweight patients with diabetes (n = 166) Diet or weight-loss counseling (y = 126) 1.02 (0.65–1.60) 1.60 (0.77–3.35) 1.02 (0.73–1.41) 0.76 (0.53–1.09) 0.74 (0.50–1.12) 1.38 (0.87–2.20) Physical activity counseling (y = 123) 0.96 (0.76–1.22) 0.82 (0.29–2.31) 1.37 (0.85–2.20) 0.79 (0.52–1.19) 0.93 (0.58–1.48) 1.12 (0.78–1.61) Obese or overweight patients without diabetes (n = 325) Diet or weight loss counseling (y = 204) 1.15 (0.99–1.34) 1.03 (0.49–2.20) 1.01 (0.69–1.48) 1.09 (0.85–1.38) 1.13 (0.79–1.61) 1.01 (0.66–1.55) Physical activity counseling (y = 195) 1.51 (1.17–1.95) 0.81 (0.45–1.45) 1.13 (0.82–1.56) 1.39 (1.04–1.86) 1.55 (1.12–2.15) 1.23 (0.91–1.66) * Glycated hemoglobin (HbA1c) assessed within the last 6 months, low-density lipoprotein (LDL) assessed within the last 12 months, and blood pressure checked during each of the last 3 visits.
† HbA1c<7.0 or HbA1c ≥7.0 and taking hypoglycemic medication; LDL ≤100 >100 and taking lipid-lowering medication; and blood pressure ≤130/85 or, if not, then taking hypertensive medication.
‡ HbA1c<7.0; LDL ≤100; and blood pressure ≤130/85.
CCM, Chronic Care Model.
- Table 4.
Hypothesis 2: Odds Ratios and Confidence Intervals Describing the Relationship between Chronic Care Model Implementation and Diabetes Care and Behavioral Counseling for Overweight/Obese Patients for Practice with Low and High Levels of Openness to Innovation*
Patient Services Openness to Innovation among Practices (odds ratio [CI]) Low High Patients with diabetes (n = 196) Assessment† 1.52 (0.79–2.92) 1.84 (1.02–3.32) Treatment‡ 2.09 (0.77–5.66) 2.06 (1.27–3.34) Target (at least 2 out of 3)§ 1.19 (0.51–2.76) 1.71 (0.13–2.58) Diet or weight loss counseling 1.27 (0.71–2.26) 1.19 (0.73–1.95) Physical activity counseling 1.17 (0.73–1.87) 1.30 (0.91–1.87) Obese or overweight patients (with or without diabetes; n = 491) Diet or weight loss counseling 1.15 (0.97–1.37) 1.03 (0.86–1.25) Physical activity counseling 1.30 (0.94–1.79) 1.60 (1.23–2.09) * Odds ratios represent the odds of appropriate service for patients within practices at the 75th percentile versus the 25th percentile of implementation of either the comprehensive Chronic Care Model or its components.
† Glycated hemoglobin (HbA1c) assessed within the last 6 months, low-density lipoprotein (LDL) assessed within the last 12 months, and blood pressure (BP) checked during each of the last 3 visits.
‡ HbA1c<7.0 or HbA1c ≥7.0 and taking hypoglycemic medication; LDL ≤100 or LDL >100 and taking lipid-lowering medication; and BP ≤130/85 or, if not, then taking hypertensive medication.
§ HbA1c<7.0; LDL ≤100; and BP ≤130/85.