Research ArticleOriginal Research

More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes

Jacqueline R. Halladay, Darren A. DeWalt, Alison Wise, Bahjat Qaqish, Kristin Reiter, Shoou-Yih Lee, Ann Lefebvre, Kimberly Ward, C. Madeline Mitchell and Katrina E. Donahue
The Journal of the American Board of Family Medicine January 2014, 27 (1) 34-41; DOI: https://doi.org/10.3122/jabfm.2014.01.130070

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Data collection timeline. BP, blood pressure; KDIS, Key Drivers Implementation Scale; LDL, low-density lipoprotein.

  • Figure 2.
    Figure 2.

    Frequency distribution of Key Drivers Implementation Scale (KIDS) scores attained at 1 year (with averages across months 10, 11, and 12) after coaching commenced by key driver.

Tables

  • Table 1. Sample of Registry Item of the Practice Assessment Scales/Key Driver Implementation Scale* in Improving Performance in Practice
    Item No.Item TitleDescription
    0No activityThere has been no activity on registry adoption or use.
    1SelectedThe practice has chosen a registry but has not yet begun using it.
    2InstalledThe practice has a registry installed on a computer and has set up a template, and entered demographic data on patients of interest (e.g., diabetes) or has outlined a process to systematically enter the data.
    3Testing workflowThe practice is testing the process for entering clinical data into the registry but is not yet using the registry to help with the daily care of patients.
    4Patient managementAll clinical data is entered into the registry and the practice is using the registry daily to plan patient care and is able to produce consistent reports on population performance.
    5Full integrationRegistry is kept up to date with a consistent and reliable process. The practice checks on and monitors the registry processes and uses the registry to manage the entire patient population.
  • Table 2. Practice Characteristics (n = 42)
    CharacteristicPractices*
    Service area
        Rural26 (62)
        Urban16 (38)
    Mean provider count (n)8.4
    Providers (n)
        ≤318 (43)
        4–613 (31)
        ≥711 (26)
    Practice specialty
        Family medicine31 (73)
        Internal medicine9 (21)
        Mixed (internal/family medicine)2 (5)
    Practice type
        Nonacademic37 (74)
        Academic5 (12)
    Insurance† (mean %)
        Medicaid (n = 35)(23)
        Uninsured (n = 33)(18)
    Practice visits per day (n = 37), n (range)73.6 (10–345)
    Uses electronic health record system22 (52)
    Study practices with baseline clinical data that reached NCQA Diabetes Recognition Program performance thresholds
        LDL levels‡ <100 mg/dL23 (37)
        Systolic blood pressure31 (36)
        Hemoglobin A1C17 (27)
    Study practices that reached IPIP goals (n)
        LDL levels‡ <100 mg/dL1
        Systolic blood pressure1
        Hemoglobin A1C4

    • Data are n (%) unless otherwise indicated.

    • ↵* Percentages listed may reflect rounding.

    • ↵† Insurance and practice visit data for several practices are missing.

    • ↵‡ One practice did not have data for low-density lipoprotein (LDL) levels.

    • NCQA, National Committee for Quality Assurance; IPIP, Improving Performance in Practice.

  • Table 3. Change in the Proportion of Patients* Meeting the Low-Density Lipoprotein Goal as a Function of Key Drivers Implementation Scale (KDIS) Score at Year 1†
    KDIS ScoreKey Drivers‡
    RegistryProtocolPlanned Care TemplateSelf-Management SupportAll 4 Drivers§
    00.89 (0.68–1.16)0.74 (0.60–0.91)1.20 (0.91–1.59)1.15 (0.94–1.40)0.78 (0.59–1.03)
    10.97 (0.78–1.20)0.88 (0.75–1.03)1.13 (0.91–1.40)1.10 (0.93–1.30)0.91 (0.74–1.11)
    21.05 (0.89–1.25)1.05 (0.89–1.25)1.05 (0.89–1.25)1.05 (0.89–1.25)1.05 (0.89–1.25)
    31.14 (0.99–1.33)1.26 (0.98–1.61)0.98 (0.84–1.15)1.01 (0.82–1.23)1.22 (0.99–1.50)
    41.24 (1.07–1.44)1.50 (1.07–2.11)0.92 (0.77–1.10)0.96 (0.75–1.24)1.42 (1.07–1.89)
    51.35 (1.13–1.61)1.80 (1.16–2.80)0.86 (0.68–1.08)0.92 (0.67–1.26)1.65 (1.13–2.41)

    • Values are presented as odds ratio (95% confidence intervals). An odds ratio greater than 1 indicates improvement between years 1 and 2. Bold values indicate statistically significant results at P < .05.

    • ↵* Proportion at the end of 2 years participation compared to 1 year.

    • ↵† Only 41 practices are included in this analysis because 1 practice did not have low-density lipoprotein data for months 10, 11, or 12; the 1-year time interval actually comprises 13 months of data reporting.

    • ↵‡ Estimates for individual key drivers are calculated holding the other 3 key driver scores at a value of 2.

    • ↵§ Indicates model estimates when all key drivers receive the same score (ie, all 3s, all 4s, etc.).

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