Abstract
ObjectiveInvestigate whether high-quality chronic care delivery improved the experiences of patients.DesignThis study had a longitudinal design.Setting and ParticipantsWe surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders.Main Outcome MeasuresPatients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness care quality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery.ResultsOverall, care quality and patients' experiences with chronic illness care delivery significantly improved. PACIC scores improved significantly from 2.89 at T1 to 2.96 at T2 and ACIC-S scores improved significantly from 6.83 at T1 to 7.18 at T2. After adjusting for patients' experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients' experiences with chronic care delivery at T2.ConclusionThis research showed that care quality and changes therein predict more positive experiences of patients with various chronic conditions over time.
Highlights
Due to an aging population and greater longevity, the prevalence of chronic conditions is rising [1]
After adjusting for patients’ experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients’ experiences with chronic care delivery at T2
We focused on disease management programs based on the chronic care model, which may serve as examples of systemic change that improves the efficiency and effectiveness of chronic care delivery [8] by combining patient-related, professionally directed and organizational interventions [26, 27]
Summary
Due to an aging population and greater longevity, the prevalence of chronic conditions is rising [1]. This growth has placed increasing demands on health-care systems and resulted in deficiencies in the organization and delivery of chronic care [2,3,4]. Health-care delivery often focuses on acute problems and rapid short-term solutions, without the initiation of chronic professional treatment or the active involvement of chronically ill patients [13]. Care delivery to chronically ill patients remains acute driven in many health-care practices, and system design has been identified as a fundamental barrier to quality improvement [9,10,11,12]
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