Assessing the Implementation of the Chronic Care Model in Quality Improvement Collaboratives

Does Baseline System Support for Chronic Care Matter?

Published in: Human Factors in Organizational Design and Management- ViI / Edited by H. Luczak and K. J. Zink (Santa Monica, CA: IEA Press, 2003), Section 4, p. 595-601

Posted on RAND.org on January 01, 2003

by Shin-Yi Wu, Marjorie L. Pearson, Judith Schaefer, Amy E. Bonomi, Stephen M. Shortell, Peter Mendel, Jill A. Marsteller, Thomas A. Louis, Emmett B. Keeler

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While collaboratives are an increasingly popular approach to facilitating quality improvement (QI) in healthcare organizations, little is known about the effective implementation of collaborative processes or organizational change activities motivated by collaborative participation. The RAND/Berkeley Improving Chronic Illness Care Evaluation of chronic care collaboratives has found overall modest levels of implementation depth, with significant variation among participant organizations. Findings suggest a nonlinear relationship between the organizations' initial assessment of their systems' support for chronic care and their subsequent QI implementation performance. Teams that begin with middle levels of support had the greatest depth of implementation. Organizations that rated their chronic care systems as more developed, the majority of which were publicly funded, were at greatest risk for poor implementation. Risk stratification of organizations and collaborative targeting of QI guidance and facilitation are discussed.

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