Assessing the implementation of the chronic care model in quality improvement collaboratives.

OBJECTIVE To measure organizations' implementation of Chronic Care Model (CCM) interventions for chronic care quality improvement (QI). DATA SOURCES/STUDY SETTING Monthly reports submitted by 42 organizations participating in three QI collaboratives to improve care for congestive heart failure, diabetes, depression, and asthma, and telephone interviews with key informants in the organizations. STUDY DESIGN We qualitatively analyzed the implementation activities of intervention organizations as part of a larger effectiveness evaluation of yearlong collaboratives. Key study variables included measures of implementation intensity (quantity and depth of implementation activities) as well as fidelity to the CCM. DATA COLLECTION/EXTRACTION METHODS We developed a CCM-based scheme to code sites' intervention activities and criteria to rate their depth or likelihood of impact. PRINCIPAL FINDINGS The sites averaged more than 30 different change efforts each to implement the CCM. The depth ratings for these changes, however, were more modest, ranging from 17 percent to 76 percent of the highest rating possible. The participating organizations significantly differed in the intensity of their implementation efforts (p<.001 in both quantity and depth ratings). Fidelity to the CCM was high. CONCLUSIONS Collaborative participants were able, with some important variation, to implement large numbers of diverse QI change strategies, with high CCM fidelity and modest depth of implementation. QI collaboratives are a useful method to foster change in real world settings.