Skip to main content

Advertisement

SpringerLink
Log in

Statewide Evaluation of Measuring Physician Delivery of Self-Management Support in Chronic Disease Care

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Self-management support is an important component of improving chronic care delivery.

OBJECTIVE

To validate a new measure of self-management support and to characterize performance, including comparisons across chronic conditions.

DESIGN, SETTING, PARTICIPANTS

We incorporated a new question module for self-management support within an existing annual statewide patient survey process in 2007.

MEASUREMENTS

The survey identified 80,597 patients with a chronic illness on whom the new measure could be evaluated and compared with patients’ experiences on four existing measures (quality of clinical interactions, coordination of care, organizational access, and office staff). We calculated Spearman correlation coefficients for self-management support scores for individual chronic conditions within each medical group. We fit multivariable logistic regression models to identify predictors of more favorable performance on self-management support.

RESULTS

Composite scores of patient care experiences, including quality of clinical interactions (89.2), coordination of care (77.6), organizational access (76.3), and office staff (85.8) were higher than for the self-management support composite score (69.9). Self-management support scores were highest for patients with cancer (73.0) and lowest for patients with hypertension (67.5). The minimum sample size required for medical groups to provide a reliable estimate of self-management support was 199. There was no consistent correlation between self-management support scores for individual chronic conditions within medical groups. Increased involvement of additional members of the healthcare team was associated with higher self-management support scores across all chronic conditions.

CONCLUSION

Measurement of self-management support is feasible and can identify gaps in care not currently included in standard measures of patient care experiences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Vogeli C, Shields AE, Lee TA, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–5.

    Article  PubMed  Google Scholar 

  2. Hardy GE Jr. The burden of chronic disease: the future is prevention. Introduction to Dr. James Marks’ presentation, “The Burden of Chronic Disease and the Future of Public Health". Prev Chronic Dis. 2004;1:A04.

    PubMed  Google Scholar 

  3. Bergeson SC, Dean JD. A systems approach to patient-centered care. JAMA. 2006;296:2848–851.

    Article  PubMed  CAS  Google Scholar 

  4. Harvey PW, Petkov JN, Misan G, et al. Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes. Aust Health Rev. 2008;32:330–8.

    Article  PubMed  Google Scholar 

  5. Bayliss EA, Bosworth HB, Noel PH, Wolff JL, Damush TM, McIver L. Supporting self-management for patients with complex medical needs: recommendations of a working group. Chronic Illn. 2007;3:167–175.

    Article  PubMed  CAS  Google Scholar 

  6. Fisher EB, Brownson CA, O’Toole ML, Shetty G, Anwuri VV, Glasgow RE. Ecological approaches to self-management: the case of diabetes. Am J Public Health. 2005;95:1523–535.

    Article  PubMed  Google Scholar 

  7. Gibson PG, Powell H, Coughlan J, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev. 2003: CD001117.

  8. Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician. 2005;72:1503–510.

    PubMed  Google Scholar 

  9. Audet AM, Davis K, Schoenbaum SC. Adoption of patient-centered care practices by physicians: results from a national survey. Arch Intern Med. 2006;166:754–9.

    Article  PubMed  Google Scholar 

  10. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288:1909–1914.

    Article  PubMed  Google Scholar 

  11. Casalino L, Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA. 2003;289:434–441.

    Article  PubMed  Google Scholar 

  12. Siminerio LM, Piatt GA, Emerson S, et al. Deploying the chronic care model to implement and sustain diabetes self-management training programs. Diabetes Educ. 2006;32:253–260.

    Article  PubMed  Google Scholar 

  13. Safran DG, Karp M, Coltin K, et al. Measuring patients’ experiences with individual primary care physicians. Results of a statewide demonstration project. J Gen Intern Med. 2006;21:13–21.

    Article  PubMed  Google Scholar 

  14. Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med. 2008;148:111–123.

    PubMed  Google Scholar 

  15. Rosenthal MB, Landon BE, Normand SL, Frank RG, Epstein AM. Pay for performance in commercial HMOs. N Engl J Med. 2006;355:1895–1902.

    Article  PubMed  CAS  Google Scholar 

  16. Glasgow RE, Peeples M, Skovlund SE. Where is the patient in diabetes performance measures? The case for including patient-centered and self-management measures. Diabetes Care. 2008;31:1046–1050.

    Article  PubMed  Google Scholar 

  17. Solomon LS, Hays RD, Zaslavsky AM, Ding L, Cleary PD. Psychometric properties of a group-level Consumer Assessment of Health Plans Study (CAHPS) instrument. Med Care. 2005;43:53–60.

    PubMed  Google Scholar 

  18. Burdine JN, Felix MR, Abel AL, Wiltraut CJ, Musselman YJ. The SF-12 as a population health measure: an exploratory examination of potential for application. Health Serv Res. 2000;35:885–904.

    PubMed  CAS  Google Scholar 

  19. Sequist TD, Schneider EC, Anastario M, et al. Quality monitoring of physicians: linking patients’ experiences of care to clinical quality and outcomes. J Gen Intern Med. 2008;23:1784–1790.

    Article  PubMed  Google Scholar 

  20. Nunnally JC, Bernstein IH. Psychometric Theory. New York: McGraw Hilll; 1994.

    Google Scholar 

  21. Pham HH, O’Malley AS, Bach PB, Saiontz-Martinez C, Schrag D. Primary care physicians’ links to other physicians through Medicare patients: the scope of care coordination. Ann Intern Med. 2009;150:236–242.

    PubMed  Google Scholar 

  22. Pham HH, Schrag D, O’Malley AS, Wu B, Bach PB. Care patterns in Medicare and their implications for pay for performance. N Engl J Med. 2007;356:1130–9.

    Article  PubMed  CAS  Google Scholar 

  23. Casalino LP. Disease management and the organization of physician practice. JAMA. 2005;293:485–8.

    Article  PubMed  CAS  Google Scholar 

  24. Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20:953–7.

    Article  PubMed  Google Scholar 

  25. Brownson CA, Miller D, Crespo R, et al. A quality improvement tool to assess self-management support in primary care. Jt Comm J Qual Patient Saf. 2007;33:408–416.

    PubMed  Google Scholar 

  26. Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002;37:791–820.

    Article  PubMed  Google Scholar 

  27. Glasgow RE, Davis CL, Funnell MM, Beck A. Implementing practical interventions to support chronic illness self-management. Jt Comm J Qual Saf. 2003;29:563–574.

    PubMed  Google Scholar 

  28. Glasgow RE, Funnell MM, Bonomi AE, Davis C, Beckham V, Wagner EH. Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetes and heart failure teams. Ann Behav Med. 2002;24:80–7.

    Article  PubMed  Google Scholar 

  29. Shetty G, Brownson CA. Characteristics of organizational resources and supports for self management in primary care. Diabetes Educ. 2007;33(Suppl 6):185S–192S.

    Article  PubMed  Google Scholar 

  30. McCormack LA, Williams-Piehota PA, Bann CM, et al. Development and validation of an instrument to measure resources and support for chronic illness self-management: a model using diabetes. Diabetes Educ. 2008;34:707–718.

    Article  PubMed  Google Scholar 

  31. Gillies RR, Shortell SM, Casalino L, Robinson JC, Rundall TG. How different is California? A comparison of U.S. physician organizations. Health Aff (Millwood). 2003: W3–492–502. Suppl Web Exclusives.

Download references

Acknowledgements

This study was funded by the California Healthcare Foundation. The funding agency played no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Sequist had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis

Conflict of Interest

Dr. Sequist serves as consultant on the Aetna External Advisory Committee on Racial and Ethnic Equality.

Author information

Authors and Affiliations

  1. Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA

    Thomas D. Sequist MD, MPH

  2. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Thomas D. Sequist MD, MPH

  3. Harvard Vanguard Medical Associates, Boston, MA, USA

    Thomas D. Sequist MD, MPH

  4. Pacific Business Group on Health, San Francisco, CA, USA

    Ted von Glahn MS

  5. Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA

    Angela Li MPH, William H. Rogers PhD & Dana Gelb Safran ScD

  6. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    Angela Li MPH, William H. Rogers PhD & Dana Gelb Safran ScD

  7. Blue Cross Blue Shield of Massachusetts, Boston, MA, USA

    Dana Gelb Safran ScD

Authors
  1. Thomas D. Sequist MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ted von Glahn MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angela Li MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William H. Rogers PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dana Gelb Safran ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas D. Sequist MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sequist, T.D., von Glahn, T., Li, A. et al. Statewide Evaluation of Measuring Physician Delivery of Self-Management Support in Chronic Disease Care. J GEN INTERN MED 24, 939–945 (2009). https://doi.org/10.1007/s11606-009-1033-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-1033-6

KEY WORDS

Search

Navigation