National Meeting 2007

1072 — Organizational Resources for Chronic Care Management

Wang M (COE Sepulveda)

Objectives:
Managing patients with multiple chronic conditions remains a top priority for VA and private-sector health care organizations. Effective chronic care management requires the support of organizational resources. However, little is known empirically about what organizational resources support chronic care management. This study was conducted to determine organizational resources associated with the implementation of the Chronic Care Model (CCM) among private-sector physician organizations (POs) affiliated with health systems or owned by hospitals.

Methods:
This study analyzed data collected by the National Study of Physician Organizations (NSPO), a cross-sectional census survey of POs (response rate = 70%) in the U.S. (September 2000 through September 2001). The studied population consisted of 1,104 POs (67% medical groups and 33% independent practice associations) employing 20 or more physicians, excluding single specialty POs such as radiology, pathology, chiropractic, podiatry, ophthalmology, anesthesiology, and/or emergency medicine. Multivariate regression analyses were performed to identify organizational resources associated with the implementation of the CCM, while adjusting for organizational and environmental characteristics. These analyses were restricted to 387 POs affiliated with health systems or owned by hospitals.

Results:
POs affiliated with health systems or owned by hospitals adopted approximately five of the eleven items in the Chronic Care Management Index (CCMI), a composite measure reflecting the extent to which the Chronic Care Model (CCM) is implemented in POs. Organizational resources associated with greater extent of CCM implementation were: (1) having an appointment system capable of scheduling for group visits and single visits that take care of multiple needs; (2) making routine phone calls to follow up on patient progress; (3) having case managers available for patients with chronic illnesses, after adjusting for other organizational features and environmental characteristics associated with implementation of chronic care management.

Implications:
Results from this study demonstrate the association between organizational resources and chronic care management. Organizational resources supporting scheduling, follow-up, and case management functionalities were associated with better chronic care management.

Impacts:
VA and private-sector managers continue to face the challenge of managing patients with chronic conditions effectively and efficiently. Findings from this study provide the basis for developing an inventory of organizational resources to support chronic care management.