Evaluation of a Chronic Care Management Program in a Rural Primary Care Clinic

Evidence supports that Chronic Care Management (CCM) is a critical component of primary care that contributes to better outcomes and higher satisfaction for patients and providers. Unfortunately, the spread of CCM services for Medicare beneficiaries to improve outcomes, lower costs, and compensate providers for care coordination has been found to be low among primary care practices. The purpose of this project was to evaluate the implementation and outcome of a chronic care management program in a rural primary care clinic for sustainability and effectiveness. The project consisted of three aims: (1) evaluate the structure and process of a CCM program in a rural primary care clinic for patients with chronic conditions; (2) evaluate the CCM program sustainability; and (3) evaluate the program effectiveness through quality patient outcomes, resource utilization, and patient and provider satisfaction. The project design was a program evaluation using a single group interrupted time series that provided a process of collecting, analyzing and using data to measure both formative and summative outcomes of a CCM program. The key findings included program sustainability and positive benefits towards patient outcomes and both patient and provider satisfaction. Rural primary care practice settings benefit from the implementation of a CCM program through improved health outcomes and satisfaction. Strategic operational design influences the ease of implementation and sustainability of the program.