Multilevel Analysis of the Chronic Care Model and 5A Services for Treating Tobacco Use in Urban Primary Care Clinics
Open accessAbstract
Objective. To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services. Methods. Cross‐sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low‐income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics. Principal Findings. Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self‐management support for cessation were 2.04–5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69–30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01). Conclusions. Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components.
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Translation research is relatively uncommon.
“Despite its importance, such translation research is relatively rare (6–8), perhaps because using current approaches translation can be arduous and slow, sometimes taking 15 to 20 years (9, 10).”
From The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions (2011) · cites this paper as [7]
There are viable models ranging from clinic staff merely referring to a state quitline or an eHealth intervention, to a chronic care model approach to disease management.
“The possibilities are legion with viable models ranging from clinic staff merely referring to a state quitline or an eHealth intervention (54, 55), to a chronic care model approach to disease management in which staff take primary responsibility for assessment, intervening, and patient tracking (7).”
From The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions (2011) · cites this paper as [7]
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The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions
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- Authors
- Hung, D. Y., & Shelley, D. R.
- Affiliations
- Columbia University (US)
- New York University (US)
- Corresponding author
- Hung, Dorothy Y.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2009-01-15
- Volume
- 44
- Issue
- 1
- Pages
- 103-127
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC2669639
- OpenAlex
- W2028266527
- Cited by
- 31
- References
- 51
- Citations by year
- 2023: 5 · 2022: 1 · 2019: 1 · 2018: 1 · 2016: 3 · 2015: 1 · 2014: 3 · 2013: 6 · 2012: 5
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Services Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- New York State Department of Health
- Agency for Healthcare Research and Quality (K02HS017007, K02-HS017007-01)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- Chronic Care Model, tobacco dependence treatment, primary health centers, urban primary care, low-income patients, delivery system design, clinical information systems, self-management support, multilevel analysis
- MeSH terms
- Adult, Chronic Disease, Cross-Sectional Studies, Decision Support Techniques, Female, Health Services Research, Humans, Male, Middle Aged, New York City, Practice Patterns, Physicians', Primary Health Care, Surveys and Questionnaires, Regression Analysis, Tobacco Use Disorder, Urban Population, Models, Organizational, Practice Guidelines as Topic, Total Quality Management, Tobacco Use Cessation
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