TY - JOUR
T1 - Improving chronic illness care
T2 - A longitudinal cohort analysis of large physician organizations
AU - Shortell, Stephen M.
AU - Gillies, Robin
AU - Siddique, Juned
AU - Casalino, Lawrence P.
AU - Rittenhouse, Diane
AU - Robinson, James C.
AU - McCurdy, Rodney K.
PY - 2009/9/1
Y1 - 2009/9/1
N2 - BACKGROUND: An increasing number of people suffer from chronic illness. Processes exist to provide better chronic illness care and yet for the most part, they are not used. OBJECTIVE: To examine the change in use of commonly recommended chronic illness care management processes (CMPs) in large medical groups between 2000 and 2006 and the factors associated with the change. DESIGN AND MEASURES: Cohort analysis of data from a national telephone survey in year 2000 and again in 2006. Participants provided information on their organizations' ownership, size, use of defined chronic illness CMPs, financial incentives, quality improvement involvement, profitability, and use of electronic medical records. SETTING: Medical groups and independent practice associations of 20 physicians or more (N = 369) that treat patients with asthma, congestive heart failure, depression, and diabetes, and that responded to the survey in 2000 and 2006. RESULTS: Use of CMP increased from 6.25 to 7.67 (of a total of 17; P ≤ 0.001), that is, by 23%, between 2000 and 2006. Increases were greatest for those practices receiving financial rewards for quality; those participating in quality improvement activities; and those practices that were profitable. Most of the increase was in use of registries and in patient self-management support services. CONCLUSIONS: There is significant opportunity for improving chronic illness care even in larger physician organizations. Public policies that promote financial rewards for improving quality and that encourage quality improvement initiatives are likely to be associated with improved chronic illness care.
AB - BACKGROUND: An increasing number of people suffer from chronic illness. Processes exist to provide better chronic illness care and yet for the most part, they are not used. OBJECTIVE: To examine the change in use of commonly recommended chronic illness care management processes (CMPs) in large medical groups between 2000 and 2006 and the factors associated with the change. DESIGN AND MEASURES: Cohort analysis of data from a national telephone survey in year 2000 and again in 2006. Participants provided information on their organizations' ownership, size, use of defined chronic illness CMPs, financial incentives, quality improvement involvement, profitability, and use of electronic medical records. SETTING: Medical groups and independent practice associations of 20 physicians or more (N = 369) that treat patients with asthma, congestive heart failure, depression, and diabetes, and that responded to the survey in 2000 and 2006. RESULTS: Use of CMP increased from 6.25 to 7.67 (of a total of 17; P ≤ 0.001), that is, by 23%, between 2000 and 2006. Increases were greatest for those practices receiving financial rewards for quality; those participating in quality improvement activities; and those practices that were profitable. Most of the increase was in use of registries and in patient self-management support services. CONCLUSIONS: There is significant opportunity for improving chronic illness care even in larger physician organizations. Public policies that promote financial rewards for improving quality and that encourage quality improvement initiatives are likely to be associated with improved chronic illness care.
KW - Chronic care model
KW - Chronic illness
KW - Financial incentives
KW - Quality improvement
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U2 - 10.1097/MLR.0b013e31819a621a
DO - 10.1097/MLR.0b013e31819a621a
M3 - Article
C2 - 19648838
AN - SCOPUS:69449088912
VL - 47
SP - 932
EP - 939
JO - Medical Care
JF - Medical Care
SN - 0025-7079
IS - 9
ER -
