UCLA

Despite evidence that care management practices (CMPs) are helpful in managing chronic illness, uneven adoption by physician organizations persists. This dissertation used an explanatory sequential mixed methods design to examine factors influencing physician organizations’ adoption of evidence-based CMPs for chronic conditions. Data were drawn from the third wave of the National Survey of Physician Organizations (NSPO3). Three distinct studies were conducted.

The first study utilized item response theory to explore whether physician organizations’ CMP adoption choices were linked, and whether adoption choices could be ordered by disease focus or CMP type. Scales for CMP type consistently ranked diabetes CMPs as the most adoptable, and depression CMPs as the least adoptable. Scales for disease focus consistently ranked patient reminders as the most adoptable CMP and clinician feedback and patient education as the least adoptable CMPs.

The second study examined contextual and organizational factors associated with CMP adoption. Results of a logistic regression conducted on the full NSPO3 sample (N=1,398) indicated that interest in patient-centered medical home accreditation or participation in an accountable care organization were among the factors associated with adoption of at least one CMP. Zero-truncated negative binomial regression conducted on the sample of organizations adopting at least one CMP (n=1,263) found that in addition to these variables, use of quality improvement systems and support of CMPs by external entities were also associated with number of CMPs adopted.

The third study explored different strategies that may be required to support uptake of diabetes CMPs in late- and non-adopting organizations, which are quite different from the early adopters typically described in the literature. Quantitative analyses were used to identify “positive deviants,” i.e., organizations that had adopted at least one diabetes CMP despite having organizational characteristics associated with non-adoption. Comparative case studies of two non-adopting and two positive deviant organizations revealed that positive deviants identified organizational priorities aligned with diabetes management and leveraged external support for CMP uptake.

Implications/Conclusion. Lessons learned from adoption patterns and positive deviants in real-world practice environments of physician organizations may be key in building strategies to promote uptake of evidence-based practices and combat variations in care.