Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care
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Background: Efforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in the health care literature, but may be related to the ability of primary care practices to improve the care they deliver. To better understand learning in primary care settings by developing a scale of learning in primary care clinics based on the literature related to learning across disciplines, and to examine the association between scale responses and chronic care model implementation as measured by the Assessment of Chronic Illness Care (ACIC) scale. Methods: Development of a scale of learning in primary care setting and administration of the learning and ACIC scales to primary care clinic members as part of the baseline assessment in the ABC Intervention Study. All clinic clinicians and staff in forty small primary care clinics in South Texas participated in the survey. Results: We developed a twenty-two item learning scale, and identified a five-item subscale measuring the construct of reciprocal learning (Cronbach alpha 0.79). Reciprocal learning was significantly associated with ACIC total and sub-scale scores, even after adjustment for clustering effects. Conclusions: Reciprocal learning appears to be an important attribute of learning in primary care clinics, and its presence relates to the degree of chronic care model implementation. Interventions to improve reciprocal learning among clinic members may lead to improved care of patients with chronic disease and may be relevant to improving overall clinic performance.
Luci K. Leykum, Holly Lanham, and Polly H. Noel are with the South Texas Veterans Health Care System and the Department of Medicine at the University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA -- RAy Palmer and Michael Parchman are with the South Texas Veterans Health Care System and the Department of Family and Community Medicine at the University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA -- Michelle Jordan is with Arizona State University, Mary Lou Fulton Teachers College, Phoenix, Arizona, USA -- Holly Lanham and Reuben R. McDaniel are with The McCombs School of Business, the University of Texas at Austin, Austin, Texas, USA