Assessing the Implementation of the Chronic Care Model in Quality Improvement Collaboratives: Does Baseline System Support for Chronic Care matter?

Abstract. While collaboratives are an increasingly popular approach to facilitating quality improvement (QI) in healthcare organizations, little is known about the effective implementation of collaborative processes or organizational change activities motivated by collaborative participa-tion. The RAND/Berkeley Improving Chronic Illness Care Evaluation of chronic care collaboratives has found overall modest levels of im-plementation depth, with significant variation among participant or-ganizations. Findings suggest a nonlinear relationship between the or-ganizations ’ initial assessment of their systems ’ support for chronic care and their subsequent QI implementation performance. Teams that begin with middle levels of support had the greatest depth of imple-mentation. Organizations that rated their chronic care systems as more developed, the majority of which were publicly funded, were at greatest risk for poor implementation. Risk stratification of organizations and collaborative targeting of QI guidance and facilitation are discussed