Table 1—

Implementation of the CCM

ElementStudy groupPhaseActivity
Community (resources and policies)CCM, PROV, and UCI–IIICommunity partnerships and collaborations were made between the University of Pittsburgh and leaders in the local community, including physicians, the community hospital foundation, and the Lion’s Clubs.
Self-management supportCCMPhase IIPatients receiving care from those providers randomized to CCM were invited to participate in six DSMT sessions that were facilitated by a certified diabetes educator (CDE) and held weekly, followed by monthly support groups. Curriculum included the required diabetes education content areas set forth by the ADA (15). The empowerment approach to diabetes education was used (22).
Delivery system designCCMPhase IIProviders randomized to CCM were encouraged to redesign the process in which they saw patients with diabetes for routine visits. A CDE was made available to them on a day of their choosing. Office staff were encouraged to schedule routine visits on these days. These “diabetes days” were designed with the idea that the provider would be more focused on diabetes for that particular day. Providers were encouraged to refer patients to the CDE for point of service education whenever possible.
Decision supportCCM and PROVPhase II and IIIOne PBL session was held for providers. An endocrinologist presented cases and lead the providers through a series of diabetes management questions. A CDE demonstrated patient-focused problem solving and goal-setting strategies. All providers received a benchmarking report, comparing their adherence with recommended process and outcome variables from the chart audit with that among their peers in the community and to the ADA standards of care (15). This was subsequently explained using academic detailing (20). The following decision support items were given to all providers regardless of study group.
UCADA standards of care for people with diabetes, flow sheets that incorporated ADA guidelines, a packet of posters and information from Pennsylvania KeyPRO and the Lower-Extremity Amputation Prevention Program to assist in complying with the ADA standards of care (15), and tracking of patient testing and results.
Clinical information systemsCCM, PROV, and UCPhase IThe majority of provider offices did not have a computer, let alone an electronic medical record, and a baseline chart audit was conducted to establish benchmarks for adherence to the ADA standards of care (15) and to enhance provider feedback.
Organizational supportCCM, PROV, and UCI–IIIThe principle investigator met with each of the providers who agreed to take part in the study to determine provider needs. This was done to enhance provider “buy in” and acknowledge chronic care as a priority. Additionally, funding was obtained from the local community hospital foundation and from the parent hospital system.
  • PBL, problem-based learning.