Developing Measures of Educational Change for Academic Health Care Teams Implementing the Chronic Care Model in Teaching Practices

Oregon Health & Science University Portland, OR 97239-3098, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 09/2010; 25 Suppl 4(S4):S586-92. DOI: 10.1007/s11606-010-1358-1
Source: PubMed


The Chronic Care Model (CCM) is a multidimensional framework designed to improve care for patients with chronic health conditions. The model strives for productive interactions between informed, activated patients and proactive practice teams, resulting in better clinical outcomes and greater satisfaction. While measures for improving care may be clear, measures of residents' competency to provide chronic care do not exist. This report describes the process used to develop educational measures and results from CCM settings that used them to monitor curricular innovations.
Twenty-six academic health care teams participating in the national and California Academic Chronic Care Collaboratives.
Using successive discussion groups and surveys, participants engaged in an iterative process to identify desirable and feasible educational measures for curricula that addressed educational objectives linked to the CCM. The measures were designed to facilitate residency programs' abilities to address new accreditation requirements and tested with teams actively engaged in redesigning educational programs.
Field notes from each discussion and lists from work groups were synthesized using the CCM framework. Descriptive statistics were used to report survey results and measurement performance.
Work groups generated educational objectives and 17 associated measurements. Seventeen (65%) teams provided feasibility and desirability ratings for the 17 measures. Two process measures were selected for use by all teams. Teams reported variable success using the measures. Several teams reported use of additional measures, suggesting more extensive curricular change.
Using an iterative process in collaboration with program participants, we successfully defined a set of feasible and desirable education measures for academic health care teams using the CCM. These were used variably to measure the results of curricular changes, while simultaneously addressing requirements for residency accreditation.

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    • "The chronic care model aims to transform the system of chronic disease care delivery from acute and reactive to proactive, planned, and population based (Coleman et al., 2009; Norris, Glasgow, Engelgau, O'Connor, & McCulloch, 2003; Tsai, Morton, Mangione, & Keeler, 2005; Wagner et al., 1996a, 1996b, 2001). This multidimensional framework was developed as a foundation for the redesign of care practices, and seeks to improve the quality of chronic care delivery through enhanced productive interactions between informed, activated patients and proactive care teams (Bowen et al., 2010). Wagner et al. (2001) designed the chronic care model based on evidence from a review of interventions to improve quality of chronic care delivery (Wagner et al., 1996a, 1996b). "
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    • "Similar to the findings of the current study, participating sites noted improvements in provider job satisfaction that corresponded with receipt of training on and delivery of the Chronic Care Model to patients, including support for patient self-management [22]. The initiatives focused on residents as ''learners'' and demonstrated increases in their exposure to self-management support strategies (range across participating sites 21–100%) [44]. Activities related to selfmanagement generally consisted of use of standardized patient self-management forms (e.g., for action planning), support for patient problem-solving, and completion of personal actions plans by the residents themselves [45]. "
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