Information system support as a critical success factor for chronic disease management: Necessary but not sufficient

Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging.ObjectiveTo identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice.DesignA prospective case study of positive deviants using key informant interviews, process observation, and document review.SettingA chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet.ParticipantsThirty community-based physician participants using predominately paper records, plus a project management team including the physician lead, project manager, evaluator and support team.AnalysisA critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice.ResultsA web-based CDM ‘toolkit’ was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology ‘factor’ was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation.ConclusionsIn complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.What was known before the study
• Known gaps in the care of patients with the chronic conditions of diabetes, congestive heart failure and depression highlight the need for improved practice and knowledge translation among primary care physicians.
• Clinical leadership and adequate resources are critical to successful knowledge translation in clinical settings.
• The Institute for Healthcare Improvement breakthrough series has been successfully applied in US primary care settings.What the study has added to the body of knowledge
• Information and communication technology was a key dimension of success in a comprehensive quality improvement framework for knowledge translation.
• Health care delivery system reform, partnerships, project management, and practice models were also necessary.
• Factors that indirectly contributed to knowledge translation through the success of the information system were: (1) listing and tracking patients, (2) allowing data sharing, (3) demonstrating performance improvement, (4) integration with workflow and (5) requiring minimal investment by physicians.