Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That are Slow to Adopt a Collaborative Chronic Care Model: A Cluster Randomized Implementation Trial

Publication Abstract

Smith, Shawna, Daniel Almirall, Katherine Prenovost, Celeste Liebrecht, Julia Kyle, Daniel Eisenberg, Mark S. Bauer, and Amy M. Kilbourne. 2019. "Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That are Slow to Adopt a Collaborative Chronic Care Model: A Cluster Randomized Implementation Trial." Medical Care, 57(7): 503-511.

Background: Implementation strategies are essential for promoting the uptake of evidence-based practices and for patients to receive optimal care. Yet strategies differ substantially in their intensity and feasibility. Lower-intensity strategies (eg, training and technical support) are commonly used but may be insufficient for all clinics. Limited research has examined the comparative effectiveness of augmentations to low-level implementation strategies for nonresponding clinics.

Objectives: To compare 2 augmentation strategies for improving uptake of an evidence-based collaborative chronic care model (CCM) on 18-month outcomes for patients with depression at community-based clinics nonresponsive to lower-level implementation support.

Research Design: Providers initially received support using a low-level implementation strategy, Replicating Effective Programs (REP). After 6 months, nonresponsive clinics were randomized to add either external facilitation (REP+EF) or external and internal facilitation (REP+EF/IF).

Measures: The primary outcome was patient 12-item short form survey (SF-12) mental health score at month 18. Secondary outcomes were patient health questionnaire (PHQ-9) depression score at month 18 and receipt of the CCM during months 6 through 18.

Results: Twenty-seven clinics were nonresponsive after 6 months of REP. Thirteen clinics (N=77 patients) were randomized to REP+EF and 14 (N=92) to REP+EF/IF. At 18 months, patients in the REP+EF/IF arm had worse SF-12 [diff, 8.38; 95% confidence interval (CI), 3.59-13.18] and PHQ-9 scores (diff, 1.82; 95% CI, -0.14 to 3.79), and lower odds of CCM receipt (odds ratio, 0.67; 95% CI, 0.30-1.49) than REP+EF patients.

Conclusions: Patients at sites receiving the more intensive REP+EF/IF saw less improvement in mood symptoms at 18 months than those receiving REP+EF and were no more likely to receive the CCM. For community-based clinics, EF augmentation may be more feasible than EF/IF for implementing CCMs.

10.1097/MLR.0000000000001138

Browse | Search | Next

PSC In The News

RSS Feed icon

S. Miller speaks with NPR's Stateside about how the Affordable Care Act boosted financial well-being along with physical health

Research Shows a Mental Health Crisis for Immigrants

Geronimus' research - Biological Weathering and Its Deadly Effect on Black Mothers

More News

Highlights

National Study of Caregiving (NSOC) Extended

Fabian Pfeffer receives Doris Entwisle Early Career Award from American Sociological Association

More Highlights


Connect with PSC follow PSC on Twitter Like PSC on Facebook