Chronic Care Management Patient Outcomes in Anticoagulant Regions

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This research study published in BioMed Central Health Services Research compared the patient outcomes between Dutch Anticoagulant Clinic (AC) regions taking into account the variations in chronic care management (CCM) in order to explore whether these CCM elements could improve the quality of oral anticoagulant therapy (OAT). This study was performed to identify the differences in patient outcomes and their relationship with chronic care management of OAT.

Complexity

The Chronic Care Model (CCM) of Wagner was used to identify the elements of chronic care management. The CCM captures six components which all conceive elements on practice level to structure chronic care such as software applications for decision support or education for self-management support. The CCM elements that were included in this questionnaire were selected and made measurable based on the literature and the expert opinion of about twenty professionals working in the thrombosis field.

The characteristics of the chronic care management identified with the questionnaire were described by five components of the CCM namely: health care organization (i.e. the organizations’ focus on chronic care for instance by incident reporting system); self-management support (i.e. supporting patients to manage their condition for instance by self-management education); delivery system design (i.e. the organization of providing care such as other roles/teams); decision support (i.e. integration of evidence-based clinical guidelines into practice for example by a reminder system) and clinical information system (i.e. systems that support the information exchange).

The identified chronic care management elements applied by the Anticoagulant Clinic regions were hypothesized to improve the chronic care management and as a consequence the patient outcomes as suggested by the CCM. Although the sixth component of the CCM – community resources and policies – was relevant for chronic care management (e.g. legislation to allow self-management), this was not taken into account in this study because the variation in this element differs on another level than the level of analysis of this study, i.e. the Anticoagulant Clinic regions

**Data Analysis:**
First, the associations between the individual chronic care elements and the quality of care were studied as shown in this dataset. These regression analyses were corrected for the type of reagent (Innovin or other reagents) which was significantly associated with quality of care (p = 0.008). The analysis showed that the variables ‘insight in waiting times’ (as proxy for patient orientation) and the ratio ‘specialized nurses versus doctors’ were associated with a significant higher number of patients within the therapeutic range. Furthermore, only the ratio ‘specialized nurses versus doctors’ are statistically significant associated with the number of patients within the target range. No statistically significant associations were observed with the number of patients below the therapeutic range.

Second, the association between the overall use of chronic care management and the patient outcomes was studied. The analysis showed that the use of more CCM components was positively associated with better patient outcomes since the number of components was associated with a higher percentage of patients within the therapeutic range (B = 1.248; p = 0.017) and target range (B = 1.358; p = 0.024). The use of more CCM components was not significantly associated with the percentage of patients below the therapeutic range (B = -0.485; p = 0.073).

Date Created

2011-11-18

Last Modified

2011-01-27

Version

2011-01-27

Update Frequency

Never

Temporal Coverage

2008

Spatial Coverage

Netherlands

Source

John Snow Labs => BioMed Central Health Services Research

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

BioMed Central / BioMed Central Health Services Research / PubMed Central / U.S. National Institutes of Health's National Library of Medicine (NIH/NLM).

Keywords

Chronic Disease, Chronic Care Model, chronic disease management, Chronic Disease Management, Chronic Disease Self-management, Wagner Chronic Care Model, Anticoagulant Therapy, Novel Anticoagulants, Anticoagulant Study, JAMA Studies, Long-term Oral Anticoagulation Therapy

Other Titles

Chronic Disease Management and Patient Outcomes, Chronic Care Model and Patient Outcomes, Disease Management in Anticoagulant Clinic Regions, Chronic Disease Self-Management and Patient Outcomes, Wagner Chronic Care Model and Patient Outcomes in AC Regions

NameDescriptionTypeConstraints
Chronic_Care_Management_ElementsDescription of the components of the Chronic Care Management used in different Dutch Anticoagulant Clinic (AC) regions.stringrequired : 1
OutcomesDescription of the outcomes observed after using the different components of the Chronic Care Managementstringrequired : 1
NotesDescription of the details of the outcome such as frequency, elements involved in the CCM and/or scale used to measure the outcome.string-
Therapeutic_Range_BetaDescribes the dosage range, blood plasma or serum concentration that is usually expected to achieve desired therapeutic effects.stringrequired : 1
Therapeutic_Range_Null_Hypothesis_ValueDescribes the null hypothesis value that is defined as the probability of obtaining a result equal to or "more extreme" than what was actually observed.string-
Target_Range_BetaDescribes the targeted drug delivery or sometimes called smart drug delivery that is a method of delivering medication to a patient in a manner that increases the potency or concentration of the medication.stringrequired : 1
Target_Range_Null_Hypothesis_ValueDescribes the null hypothesis value that is defined as the probability of obtaining a result equal to or "more extreme" than what was actually observed.string-
Chronic_Care_Management_ElementsOutcomesNotesTherapeutic_Range_BetaTherapeutic_Range_Null_Hypothesis_ValueTarget_Range_BetaTarget_Range_Null_Hypothesis_Value
Health care organizationClient board-3.0010.304-3.0960.359
Decision supportFormal agreements with hospitals0.0970.9410.350.817
Health care organizationAccreditation(no/once/more than once)1.2250.1241.2650.17
Self management supportPercentage of self management patients21.450.1098.0970.604
Delivery system (re)designSpecialized nurses versus doctors0.1310.035*0.1660.020*
Delivery system (re)designRegional multidisciplinary meeting-0.2550.898-2.1350.352
Self management supportSelf-management support with webbased application-2.5830.077-3.1030.065
Decision supportInformation from the hospitalfrom scale 0-10 (slow to fast)-0.090.8930.4630.364
Clinical information systemsWeb based patient information for dosage advice0.3460.844-1.3030.521
Self management supportFrequency of self management control by Anticoagulant Clinic0.6160.1980.2590.641