5.3 Results
5.3.2 Descriptive statistics
Table 5.7 shows the mean score of each variable under ACIC sub-scale. Each ACIC sub-scale score is the group mean of the respective variables of that sub-scale. The overall program score is the mean of all sub-scales scores.
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Table 5.6: Cronbach’s Alpha coefficients for ACIC variables
ACIC Sub-scales Cronbach's
Alpha
Cronbach's Alpha if item deleted Organisation of healthcare delivery system
Organisational leadership
.928
.915
Organisational goals .913
Improvement strategy .901
Incentives and regulations .908
Senior leaders .917
Benefits .932
Community linkages
Linking to outside resources
.881
.835
Partnership with community organisations .848
Regional health plans .811
Self-management
Assessment and documentation of self-management needs
.927
.919
Self-management support .895
Address concerns .922
Effective behaviour change interventions .884
Decision support Evidence-based guidelines .873 .818 Involvement of specialists .880 Provider education .826
Informing patients about guidelines .829
Delivery system design
Practice team functioning
.920
.900
Practice team leadership .901
Appointment system .892
Follow-up .908
Planned visits .917
Continuity of care .914
Clinical information system
Registry
.831
.784
Reminder to provider .783
Feedback .790
Information about relevant sub-groups of patients
needing services .786
Patient treatment plans .837
Integration of CCM components
Informing patients about guidelines
.815
.760
Information systems/database .798
Community programs .808
Organisational planning .806
Routine follow-up for appointments, assessments and
goal planning .772
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Table 5.7: Distribution of ACIC scores
ACIC sub-scales Mean Mode Std. Deviation
Organisation of healthcare delivery system 5.8 6.2 1.9
Organisational leadership 6.1 6 2.4 Organisational goals 5.5 6 2.1 Improvement strategy 5.5 4 2.2 Incentives and regulations 4.2 2 2.7
Senior leaders 6.7 7 2.1
Benefits 6.4 7 2.1
Community linkages 5.6 5.0 2.2
Linking to outside resources 5.5 5 2.6 Partnership with community organisations 6.0 6 2.3 Regional health plans 5.0 5 2.4
Self-management 5.6 4.0 2.4
Assessment and documentation of self-management needs 5.2 5 2.7 Self-management support 5.6 4 2.8 Address concerns 5.6 5 2.6 Effective behaviour change interventions 6.1 7 2.5
Decision support 5.3 3.5 2.3
Evidence-based guidelines 6.2 4 2.4 Involvement of specialists 4.9 2 3.0 Provider education 4.9 4 2.5 Informing patients about guidelines 5.3 4 2.5
Delivery system design 5.7 3.0 2.5
Practice team functioning 5.7 4 2.7 Practice team leadership 5.8 4 2.9 Appointment system 5.2 2 3.5
Follow-up 5.0 3 3.2
Planned visits 5.8 3 3.0
Continuity of care 6.5 7 2.3
Clinical information system 4.1 2.4 2.3
Registry 3.6 1 3.2
Reminder to provider 2.8 2 2.2
Feedback 4.2 2 3.0
Information about relevant sub-groups of patients needing
services 4.5 4 2.9
Patient treatment plans 5.4 4 2.9
Integration of CCM components 4.4 4.2 2.2
Informing patients about guidelines 5.3 4 2.5 Information systems/database 3.2 1 2.8 Community programs 2.9 1 2.0 Organisational planning 3.5 5 2.5 Routine follow-up for appointments, assessments and goal
planning 5.2 4 2.4
Guidelines for chronic care 5.4 3 2.4
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Table 5.7 and Figure 5.1 show that the ACIC sub-scale scores are within the range of 4.1 to 5.8. The sub-scale scores are: organisation of healthcare delivery system (5.8); community linkage (5.6); self-management (5.6); and delivery system design (5.7). These sub-scale scores demonstrate reasonably good support for chronic care. Among all the sub-scale scores, clinical information system (4.1), integration of CCM
components (4.4), and decision support (5.3) sub-scales demonstrate basic level of functioning.
On a scale of 0 (limited support) to 11 (full support for chronic care), the scores are within the basic to reasonably good support for chronic care. The overall program score is 5.3 indicating a basic support for chronic care. The result shows that the clinical information system is least developed. A real disease register and a functional system to remind providers are not in place.
The ACT diabetes and cancer services have well developed service specific databases or information systems, but the real disease register is not available. As a result of the influence of clinical information systems, the overall integration of CCM components showed a basic support for chronic care within ACT Health.
According to the measurement scale and levels, the above-mentioned results provide a gross interpretation of the sub-scale specific scores and overall score. The mode and standard deviation in Table 5.7 provides better explanations about the scores.
The mode in this table extracts common scores recorded by a high number of the respondents and the standard deviation calculates the difference between each variable score with the mean score (Argyrous 1998).
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Figure 5.1: Distribution of ACIC scores by level
The interpretation of mean score and mode utilise the descriptions of ACIC variables according to their levels.
Under the ‘organisation of healthcare delivery system’ sub-scale, the modes for variables like organisational leadership, goal, senior leaders and benefits have clear relationship with the mean scores. The means of these variables are at the lower limit within the scale of ‘reasonably good support’ band of chronic care. The mean score for the ‘improvement strategy’ variable lies within the reasonably good support range. However, the mode lies within the ‘basic support’ level. The mode is lower than the mean because a few respondents gave high scores on the variables comprising this theme (pulling up the mean), but most of the respondents gave scores between 2.5 and 5.5 (and the mode reflects this). Given this, the mode is a more reliable indicator of what most respondents think. According to the description used in the ACIC survey instrument (see Attachment 3), ‘basic support’ means that the organisation develops strategies on an ad-hoc basis to address chronic care issues as they emerge. The
‘incentives and regulations for chronic care’ variable score is at basic support level, but most of the respondents scored it at limited support level. This finding suggests that the
5.7 5.6 5.6 5.8 5.3 4.4 4.1 5.3 3.5 4 4.5 5 5.5 6 6.5 7 Overall Integration of CCM components Clinical information system Delivery system design Decision support Self-management Community linkages Organisation of healthcare delivery system
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incentives and regulations for chronic care are not favourable for providers in achieving patient care goals.
The ‘community linkages’ sub-scale variables have mean scores consistent with their mode. The respondents mostly scored the variables at the upper limit of the ‘basic support’ level except for the ‘partnership with community organisations’ variable. This variable obtained a score at the lower limit of ‘reasonably good support’ level. This explains that ACT Health has supportive programs and policies to create linkage with community resources for CDM. These above two sub-scales describe the organisation’s specific attention to CDM initiatives. The next four ACIC sub-scales’ data present the status of chronic care services.
The self-management sub-scale score shows that ACT Health is implementing reasonably good behaviour change interventions and peer support programs for the patients and their families.
The mean scores of ‘self-management support’ and ‘addressing concern for patients and families’ variables demonstrate that the organisation provides these supports through trained clinical educators.
The mean score of ‘assessment and documentation of self-management needs and activities’ is at 5.2. This finding denotes that the provider organisations do not adequately document patient assessment findings and link that with patient treatment plans. This finding calls for standardised documentation of patient assessment findings to engender next actions.
The mean score for decision support is at ‘basic support’ level. All the variables of this sub-scale, except for the ‘evidence-based guidelines’ have scores at basic support level.
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The mean score of ‘involvement of specialist’ variable is 4.9 but the mode is 2. The mode explains that the involvement of physicians or specialists with chronic care is only through the traditional referral process. The physicians or specialists have inadequate participation to enhance the health system capacity to implement evidence-based guidelines.
The ‘delivery system design’ sub-scale has six variables. The variables ‘appointment system’ and ‘follow-up’ have mean scores of 5.2 and 5.0 respectively (basic support level). While looking at the mode of these variables, the distribution of the highest number responses is within the range limited to basic support level for chronic care.
The mean scores of all the five variables of the clinical information system sub-scale lie within the basic support level. However, the mode for first three variables (registry, reminder to provider and feedback) lie within the limited support level.
Table 5.8 shows the means scores of ACIC sub-scales of 42 surveys. In this Table there are some missing values, which denote that the respective respondents had not put any score for any of the variables within that sub-scale.
The box and whisker plot in Figure 5.2 shows the range of the distribution of the plot, which is the difference between the minimum and maximum values. Figure 5.2 presents the 25-75 percentile range of scores of each ACIC sub-scale of 42 survey responses. The vertical line within the box is the median and the whiskers shows the extent of scores (Kirkwood and Sterne 2003).
The figure also shows the placement of boxes and median within the four levels of scales.
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Table 5.8: Distribution of ACIC sub-scale scores by respondents
ID Organisation of healthcare delivery system Community linkages Self- management Decision support Delivery system design Clinical information system Integration of CCM components Overall 1 4.3 5.7 4.0 3.5 4.2 2.4 4.2 4.0 2 4.2 4.0 3.5 2.5 2.8 1.8 2.8 3.1 3 4.0 4.7 6.5 3.8 4.5 4.2 4.3 4.6 4 4.2 5.0 4.3 5.3 3.3 2.4 3.3 4.0 5 3.0 5.5 9.5 8.3 10.0 9.0 5.8 7.3 6 6.3 9.0 8.0 9.0 8.1 7 8.0 5.5 7.0 6.8 8 2.5 2.0 1.0 3.5 1.2 2.8 2.5 2.2 9 9.3 8.7 8.3 8.5 9.5 7.8 7.2 8.5 10 4.8 3.0 5.8 4.8 4.2 2.4 4.2 4.2 11 5.0 5.0 4.8 5.0 4.3 3.6 3.7 4.5 12 6.0 3.7 4.0 5.3 4.2 2.4 2.5 4.0 13 6.3 3.3 2.5 3.3 3.0 2.6 2.3 3.3 14 4.8 8.7 8.5 7.8 10.3 8.2 6.3 7.8 15 4.3 4.7 3.5 2.0 2.7 1.8 1.8 3.0 16 6.3 2.3 8.5 4.5 5.2 1.3 5.3 4.8 17 7.5 6.0 7.3 4.3 6.5 5.0 4.5 5.9 18 6.2 5.0 5.0 5.5 6.3 . 5.0 5.5 19 10.7 11.0 11.0 11.0 9.8 8.8 11.0 10.5 20 8.5 7.3 7.0 5.0 8.2 5.0 5.5 6.6 21 1.5 1.7 1.0 2.0 1.0 0.0 0.2 1.0 22 4.0 5.3 4.3 2.8 3.8 3.6 1.7 3.6 23 6.2 5.3 4.3 3.0 5.7 4.4 3.8 4.7 24 8.3 4.0 6.8 7.8 5.2 5.4 6.7 6.3 25 6.0 10.3 6.2 0.0 5.6 26 3.8 3.3 2.8 3.5 3.3 1.4 3.8 3.1 27 5.8 6.7 7.8 5.0 6.7 5.4 6.2 6.2 28 5.7 7.0 5.3 7.0 6.5 4.8 4.8 5.9 29 5.5 4.3 7.5 7.0 9.2 5.6 5.8 6.4 30 5.5 5.0 2.5 4.3 7.8 4.0 1.7 4.4 31 8.7 8.3 8.0 8.0 8.8 8.0 8.0 8.3 32 2.8 3.7 5.0 3.5 3.0 3.0 4.8 3.7 33 6.8 6.3 4.0 5.3 7.2 3.8 4.7 5.4 34 6.2 9.3 9.0 8.3 8.5 8.0 6.0 7.9 35 6.3 5.3 6.3 5.8 6.7 5.8 6.0 6.0 36 7.3 6.3 7.5 7.5 6.5 5.0 4.2 6.3 37 5.0 5.0 4.0 3.3 2.5 2.8 2.0 3.5 38 5.8 6.0 7.3 8.0 7.2 1.0 3.8 5.6 39 6.2 5.0 5.3 5.3 6.3 4.8 4.2 5.3 40 4.7 5.3 . 2.0 3.0 2.0 4.5 3.6 41 8.8 7.3 7.0 7.8 6.7 2.0 5.0 6.4 42 4.3 2.7 2.5 2.3 3.3 3.0 2.5 2.9
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Figure 5.2: ACIC survey of ACT Health showing sub-scale medians, 25–75 percentiles and range