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Understanding effective care management implementation in primary care: a macrocognition perspective analysis.

Jodi Summers Holtrop¹, Georges Potworowski², Laurie Fitzpatrick³

¹Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E 17th Avenue, Mail Stop F496, Room 3505 Academic Office 1, Aurora, CO, 80045, USA. Jodi.holtrop@ucdenver.edu.

Implementation Science : IS

|August 22, 2015

Summary

Implementing care management in primary care is challenging but achievable. Successful practices utilized macrocognition (thinking about thinking) more frequently to navigate complex changes in patient care and decision-making.

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Area of Science:

Healthcare Management
Cognitive Science
Primary Care Research

Background:

Care management in primary care improves chronic disease outcomes but faces implementation challenges.
Implementation requires significant changes in workflows, decision-making, and information sharing.
The macrocognition perspective offers tools to study cognitive aspects of complex implementation.

Purpose of the Study:

To explore the role of macrocognition in the implementation of care management in primary care settings.
To understand how cognitive processes influence the success of complex intervention implementation.

Main Methods:

Employed cognitive task analysis using a macrocognition framework.
Conducted semi-structured interviews and observations at five primary care practices over 9 months.
Utilized qualitative coding and analysis with an editing and template approach.

Main Results:

Varied implementation success was observed across the five practices.
Higher utilization of macrocognition functions correlated with greater care management implementation success.
Macrocognition effectively explained differences in implementation outcomes.

Conclusions:

Successful implementation of complex interventions like care management is feasible.
The macrocognition perspective is valuable for identifying and addressing implementation facilitators and barriers.
Understanding cognitive elements is crucial for planning and executing new clinical interventions.