Assessment of a chronic care program in Gerona (CRONIGICAT)

OBJECTIVE: To determine the utility and viability of a chronic care program. DESIGN: Cross-sectional descriptive study with qualitative and quantitative evaluation. SETTING AND PARTICIPANTS: 26 primary care teams (PCT) from the Catalan health service of Gerona. INTERVENTIONS: 20 projects within the program. Start 2011. MAIN OUTCOME MEASURES: The degree of development of the program, consensus indicators for chronic care, and the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluacion de Modelos de Atencion ante la Cronicidad [IEMAC]). RESULTS: Evaluation of the degree of development: 75% of projects were partially or fully implemented, with a high degree of development in 71% of the PCT. An increasing tendency was found in the consensus indicators for process (patients contacted 48 hours after hospital discharge, population attended in chronic care programs and with the highest risk stratification). There was a slight decrease in the consensus indicators for effectiveness (readmissions, mean length of hospital stay, avoidable hospital admissions, pharmaceutical expenditure, patients attended in the emergency department, and mortality). The dimensions receiving the highest scores on the IEMAC were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care. CONCLUSIONS: When assessing the utility of CRONIGICAT, we believe that progress has been made mainly in its implantation, which has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. We believe that the CRONIGICAT is viable and sustainable, since its actions and projects are integrated within routine clinical practice.