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.