ArticleJournal of general internal medicine2018
Implementation of the Chronic Care Model to Reduce Disparities in Hypertension Control: Benefits Take Time.
Article in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Electronic Health Record-Driven Approaches in Primary Care to Strengthen Hypertension Management Among Racial and Ethnic Minoritized Groups in the United States: Systematic Review.Journal of medical Internet research · 2023Pooled it
- Strategies to Address Racial and Ethnic Disparities in Health and Health Care for Chronic Conditions : An Evidence Map of Research From 2017 to 2024.Annals of internal medicine · 2025Review
- Racial/ethnic and HIV risk category disparities in preexposure prophylaxis discontinuation among patients in publicly funded primary care clinics.AIDS (London, England) · 2019Article
- Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services.Inquiry : a journal of medical care organization, provision and financingObservational
- Improving Quality Improvement Capacity and Clinical Performance in Small Primary Care Practices.Annals of family medicineArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Chronic Care Model (CCM) has been endorsed by experts to reduce disparities in chronic disease outcomes but benefits may be slow to appear in low-income populations.
objectiveTo evaluate the effect of CCM implementation on systolic blood pressure (SBP) control in minority patients with diabetes mellitus (DM).
designRetrospective study from 2012 to 2016 in two primary care clinics with primarily uninsured, Hispanic patients. PATIENTS: Four 2-year cohorts of patients aged 18-75 with DM and SBP ≥ 140 mmHg on HTN drugs in year 1 and SBP measured 1 year later in year 2.
interventionImplementation of CCM for DM in January 2014 involved: electronic medical record revision, a DM registry, hypertension (HTN) treatment protocol, team education, performance feedback, and case management. MAIN MEASURE: SBP < 140 mmHg in year 2. KEY
resultsOf 2354 patients, the mean age was 56.2 (SD 9.5), baseline SBP 153.8 (SD 14.9) mmHg, and 79.8% Hispanic. Last SBP < 140 mmHg was 58.4% for cohort 1 (2012-2013) and 68.5% for cohort 4 (2015-2016). Adjusted odds ratios (AORs) for SBP control versus cohort 1 were 1.35 (95% CI 1.07, 1.69) for cohort 3 (2014-2015) and 2.13 (95% CI 1.60, 2.80) for cohort 4. AORs for SBP control were reduced by 15% per HTN drug at baseline (P = 0.001), 9% per HTN drug added at last SBP (P = 0.024), and 22% for multi-dose HTN drugs (P = 0.004). Among patients with persistent elevated SBP and represented in multiple cohorts, AORs for control were still over 2-fold higher for cohort 4 versus cohort 1.
conclusionsAfter adopting the CCM for primarily Hispanic patients with DM, SBP control increased significantly despite treatment with fewer HTN drugs. Yet improvement took 3-4 years, suggesting that financial rewards for using the CCM to achieve improved clinical outcomes for low-income, minority patients may be delayed.
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