PT  - JOURNAL ARTICLE
AU  - Jacqueline R. Halladay
AU  - Darren A. DeWalt
AU  - Alison Wise
AU  - Bahjat Qaqish
AU  - Kristin Reiter
AU  - Shoou-Yih Lee
AU  - Ann Lefebvre
AU  - Kimberly Ward
AU  - C. Madeline Mitchell
AU  - Katrina E. Donahue
TI  - More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes
AID  - 10.3122/jabfm.2014.01.130070
DP  - 2014 Jan 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 34--41
VI  - 27
IP  - 1
4099  - http://www.jabfm.org/content/27/1/34.short
4100  - http://www.jabfm.org/content/27/1/34.full
SO  - J Am Board Fam Med2014 Jan 01; 27
AB  - Objective: Chronic disease collaboratives help practices redesign care delivery. The North Carolina Improving Performance in Practice program provides coaches to guide implementation of 4 key practice changes: registries, planned care templates, protocols, and self-management support. Coaches rate progress using the Key Drivers Implementation Scales (KDIS). This study examines whether higher KDIS scores are associated with improved diabetes outcomes. Methods: We analyzed clinical and KDIS data from 42 practices. We modeled whether higher implementation scores at year 1 of participation were associated with improved diabetes measures during year 2. Improvement was defined as an increase in the proportion of patients with hemoglobin A1C values <9%, blood pressure values <130/80 mmHg, and low-density lipoprotein (LDL) levels <100 mg/dL. Results: Statistically significant improvements in the proportion of patients who met the LDL threshold were noted with higher “registry” and “protocol” KDIS scores. For hemoglobin A1C and blood pressure values, none of the odds ratios were statistically significant. Conclusions: Practices that implement key changes may achieve improved patient outcomes in LDL control among their patients with diabetes. Our data confirm the importance of registry implementation and protocol use as key elements of improving patient care. The KDIS tool is a pragmatic option for measuring practice changes that are rooted in the Chronic Care Model.