Development of IT-enabled Chronic Care Management for the Medically Underserved: A Contextualist Framework

While efforts to address the management of chronic diseases in the context of large, urban hospitals are underway, the literature is silent on how to facilitate such efforts in the community clinics that provide services to many chronic-care patients who are medically underserved. We offer a contextualist framework for developing IT-enabled chronic care management in community clinics. To understand and support the required collaboration between diverse stakeholders located across institutional boundaries, the framework adapts Pettigrew’s Contextual Inquiry as the overarching analytical lens. The framework focuses on the context of community clinics, including patients, clinicians, administrators, technology providers, and institutional partnerships; it considers the content of developing IT-support based on the Chronic Care Model, and, as basis for the development process, it adapts Holtzblatt and Beyer’s Contextual Design principles. We demonstrate the workings of the framework through a case study of how IT-enabled support for chronic care management was designed and implemented into a community clinic in the Southeast U.S. over a three-year period, and, finally, we discuss its theoretical and practical implications in relation to extant literature.