Facilitators and barriers of implementing the chronic care model in primary care: a systematic review.

Mudathira K Kadu,Paul Stolee

doi:10.1186/s12875-014-0219-0

Abstract

BackgroundThe Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation.MethodsThis study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation.ResultsThis review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs.ConclusionsThese findings highlight the importance of assessing organizational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers’ and organizational perspective.

Highlights

The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care
Despite the extensive evaluation of quality improvement (QI) initiatives, and research on CCM-based interventions, across the United States, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake [10,14,17,18]
Data sources This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings

Summary

Introduction

The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. Kadu and Stolee BMC Family Practice (2015) 16:12 disease management, and little coordination and communication among care providers [7]. In response to these challenges and the call for redesigning care delivery for chronic diseases, Wagner and colleagues developed the Chronic Care Model (CCM) [8,9]. It posits six interrelated elements that are key to high quality chronic disease care: self-management support, redesigning delivery systems, decision support that is system wide, clinical information technology, linkages to community resources, and health care system organization [10,11]. The CCM and its various components have been widely adopted and evaluated, with results showing that it improves patient care and clinical outcomes, and reduces care utilization and costs [12,13,14,15,16]

Methods

Results

Conclusion