RT Journal Article
SR Electronic
T1 More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 34
OP 41
DO 10.3122/jabfm.2014.01.130070
VO 27
IS 1
A1 Halladay, Jacqueline R.
A1 DeWalt, Darren A.
A1 Wise, Alison
A1 Qaqish, Bahjat
A1 Reiter, Kristin
A1 Lee, Shoou-Yih
A1 Lefebvre, Ann
A1 Ward, Kimberly
A1 Mitchell, C. Madeline
A1 Donahue, Katrina E.
YR 2014
UL http://www.jabfm.org/content/27/1/34.abstract
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 &lt;9%, blood pressure values &lt;130/80 mmHg, and low-density lipoprotein (LDL) levels &lt;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.