The Program Being Evaluated
In 1999, the Robert Wood Johnson Foundation (RWJF) awarded Partnerships for Quality Education (PQE) a grant of $8.9 million to continue its work in developing new models for education. With funding from RWJF, PQE continued its work on the Partnerships Program, and added initiatives in teamwork (Collaborative Interdisciplinary Team Education) and chronic illness management (Take Care to Learn). In 2003, PQE launched the Achieving Competence Today (ACT) initiative to help residency and nurse practitioner programs transform teaching around systems and practice improvement.
Take Care to Learn: Teaching Clinical Care Management (TCTL) supported the development of chronic illness management initiatives in asthma and diabetes to serve as platforms for innovative education in managing care.
About the Evaluation
Michael Yedidia, a professor at Rutgers University, and Jessica Greene, an assistant professor at the University of Oregon, Eugene, conducted the evaluation of TCTL.
The evaluators sent surveys to all TCTL learners at the beginning of the projects in the summer of 2002 and at the end in the summer of 2003. At the same time, they sent the same surveys to a comparison group whose members were similar to the TCTL learners but not engaged in TCTL projects. In all, 207 TCTL learners from nine projects completed both surveys, as did 85 learners from the comparison group.
To assess learners' confidence in their ability to deliver effective chronic care, the survey included sets of questions measuring each of three outcomes:
- Ability to mobilize resources for implementing the chronic care model (a 6-item scale).
- Ability to perform tasks that supported patients' self-management of their disease (a 7-item scale).
- Ability to address challenging patient care issues in chronic illness management (a 9-item scale).
The evaluators also surveyed patients of TCTL learners at all projects in late 2002 and early 2003 to elicit their perceptions of provider support for self-management, a key element of the chronic care model. Surveys were completed by an ethnically diverse, primarily low-income sample of 956 patients (or parents of pediatric patients) with diabetes or asthma. There was no comparison group.
Knowledge and Impact
Findings about TCTL learners included:
- Ability to mobilize relevant resources for implementing the chronic care model: TCTL learners reported significantly more improvement than their counterparts in the comparison group.
- Ability to support patient self-management of their conditions: TCTL learners reported more improvement than the comparison group.
- Ability to address challenging patient care issues in chronic disease management: TCTL learners reported more improvement than the comparison group.
Findings about Patients included:
- Patients (or parents of child patients) who view health care providers as highly supportive of their self-management efforts, reported greater confidence in caring for their (or their child's) conditions.
- Diabetes patients with highly positive assessments of their provider's support, reported engaging in illness self-management approximately one day more per week than those who held negative views.
- These relationships between patients' confidence in caring for their (or their child's) condition and their view of their physician were significant for patients with either asthma or diabetes and from varied socioeconomic backgrounds.
According to Yedidia, these findings from the patients provide evidence of the validity of the measure of provider support, its broader relevance to underserved populations, and its usefulness for evaluating quality of care and assessing training programs such as those initiated by PQE. See Program Results Report for additional information.