Patient Experience During a Practice Facilitation Intervention to Implement the Chronic Care Model

Abstract

Background: Although practice facilitation is a promising strategy for practice improvement in primary care, less is known about whether facilitated interventions improve care from the patient perspective. We examined the effect of a practice facilitation intervention to implement the Chronic Care Model (CCM) on patient-reported quality of chronic illness care. Methods: We conducted a pre-post analysis of patient surveys collected in 16 small, community-based primary care practices participating in a 2007 trial of practice facilitation to implement the CCM. Two cross-sectional samples of adult patients with at least 1 chronic illness completed the Patient Assessment of Chronic Illness Care (PACIC) survey pre-intervention and 12 months post-intervention. A practice facilitator met with practices for 12 months to assist in implementing strategies guided by the CCM. Practice mean PACIC summary and subscale scores pre- and post- intervention were compared using paired t-tests. Results: Across the 16 practices, 595 patients pre-intervention (range: 17-52 per practice) and 816 post-intervention (range: 17-62 per practice) were included in the analysis. There was a significant decrease in practice mean PACIC summary scores from pre-intervention 3.35 (SD 0.29) to post-intervention 3.09 (0.32), p = 0.03. All 5 subscales also decreased, reaching significance in 3 of the 5 domains: Patient Activation, Delivery System/Decision Support, and Problem-Solving (p<0.05). Conclusions: We found that a practice facilitation intervention to implement the CCM was associated with a decline in patient-reported quality of chronic illness care. More attention to patient experience when implementing practice change is warranted.