Adapting the Chronic Care Model to Treat Chronic Illness at a Free Medical Clinic

Johns Hopkins University, Baltimore, Maryland, United States
Journal of Health Care for the Poor and Underserved (Impact Factor: 1.1). 06/2005; 16(2):286-96. DOI: 10.1353/hpu.2005.0041
Source: PubMed

ABSTRACT This pilot project was designed to determine the feasibility and effectiveness of an adaptation of the chronic care model applied to uninsured patients in a free medical clinic staffed by volunteer physicians. Of the 149 enrolled patients, 117 had hypertension, 91 had diabetes, and 51 had hyperlipidemia. Patients were enrolled in a chronic disease registry from March 1, 2001 through September 30, 2002 at the Salvation Army Free Clinic (SAFC). Two part-time registered nurses served as care managers providing disease-specific management using evidence-based guidelines. Consistent specialty consultation was available via phone, e-mail, or physician visit. Patient self-management was encouraged through collaborative goal setting. There were 40 patients lost to follow-up; 109 completed the study. A clinically significant improvement was obtained in at least one chronic disease for 79 patients. The chronic care model was a useful template for the delivery of effective chronic disease care to a group of uninsured patients at a free medical clinic.

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Available from: Todd R Huschka, Sep 25, 2015
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    • "These authors found that there was more use of recommended processes that assure quality care in these primary care practices, and they also found improved intermediate outcomes of care for their patients with diabetes. Stroebel et al. (2005) conducted a pilot project to determine the feasibility and effectiveness of an adaptation of the CCM and found that the CCM was successfully used as a template for the delivery of chronic disease care to an uninsured population . Vargas et al. (2007) demonstrated that using a collaborative intervention for diabetes lowered cardiovascular disease risks for patients with diabetes when compared to usual care. "
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    ABSTRACT: Although promising research is developing related to promotores and the Chronic Care Model (CCM), studies of the effectiveness of the integration of these two system innovations in addressing health disparities are limited. This article reports on an organizational assessment and analysis of promotores working in a system of federally-sponsored community health clinics along the United States-Mexico border where the CCM has been operationalized. The work of promotores was found to be largely invisible within the CCM. This highlights the need for further investigation if the potential of these combined system innovations to address health disparities among Hispanics is to be realized.
    Journal of Community Health Nursing 04/2011; 28(2):70-80. DOI:10.1080/07370016.2011.564060 · 0.48 Impact Factor
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    • "Despite strong evidence supporting the use of health risk assessments, behavioral counseling, and referral to community-based programs, we found that they were infrequently offered by a nationwide sample of primary care practices. In addition, this study found incomplete implementation of the CCM, which is consistent with earlier research findings (Rundall et al. 2002; Stroebel et al. 2005; Tsai et al. 2005; Wagner et al. 1999; Wagner, Glasgow, et al. 2001). In particular, office tools and information systems that improved delivery system design, decision support, and access to patient data were either not available or not regularly used. "
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    ABSTRACT: This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such as tobacco use, risky drinking, unhealthy dietary patterns, and physical inactivity. Data were obtained from primary care practices participating in a national health promotion initiative sponsored by the Robert Wood Johnson Foundation. Practices owned by a hospital health system and exhibiting a culture of quality improvement were more likely to offer recommended services such as health risk assessment, behavioral counseling, and referral to community-based programs. Practices that had a multispecialty physician staff and staff dieticians, decision support in the form of point-of-care reminders and clinical staff meetings, and clinical information systems such as electronic medical records were also more likely to offer recommended services. Adaptation of the CCM for preventive purposes may offer a useful framework for addressing important health risk behaviors.
    Milbank Quarterly 02/2007; 85(1):69-91. DOI:10.1111/j.1468-0009.2007.00477.x · 3.38 Impact Factor
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    ABSTRACT: For the final assignment in this class on theory development, I asked these creative nursing PhD students to either adapt or extend an existing midrange theory.The following papers represent great hope for the future of nursing knowledge, and we offer them as evidence to interested readers at any level who want to know why theory matters, how it relates to actual practice, and why the voices of reflective nurses at all levels of educational attainment are needed to advance our thinking and unfolding in the context of all health professions. Sincerely, Jennifer B. Averill, PhD, RN, Instructor
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