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J Am Board Fam Med. 2014 Jan-Feb;27(1):34-41. doi: 10.3122/jabfm.2014.01.130070.

More extensive implementation of the chronic care model is associated with better lipid control in diabetes.

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  • 1the Department of Family Medicine and the Division of General Medicine and Clinical Epidemiology, Cecil G. Sheps Center for Health Services Research, and the Departments of Biostatistics and Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill; the Department of Health Policy and Management, University of Michigan School of Public Health, Ann Arbor; and the North Carolina Area Health Education Centers, Chapel Hill.



Chronic disease collaboratives help practices redesign care delivery. The North Carolina Improving Performance in Practice program provides coaches to guide implementation of 4 key practice changes: registries, planned care templates, protocols, and self-management support. Coaches rate progress using the Key Drivers Implementation Scales (KDIS). This study examines whether higher KDIS scores are associated with improved diabetes outcomes.


We analyzed clinical and KDIS data from 42 practices. We modeled whether higher implementation scores at year 1 of participation were associated with improved diabetes measures during year 2. Improvement was defined as an increase in the proportion of patients with hemoglobin A1C values <9%, blood pressure values <130/80 mmHg, and low-density lipoprotein (LDL) levels <100 mg/dL.


Statistically significant improvements in the proportion of patients who met the LDL threshold were noted with higher "registry" and "protocol" KDIS scores. For hemoglobin A1C and blood pressure values, none of the odds ratios were statistically significant.


Practices that implement key changes may achieve improved patient outcomes in LDL control among their patients with diabetes. Our data confirm the importance of registry implementation and protocol use as key elements of improving patient care. The KDIS tool is a pragmatic option for measuring practice changes that are rooted in the Chronic Care Model.


Chronic Disease; Diabetes Mellitus; Primary Health Care; Quality Improvement

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