Effect of care management program structure on implementation: a normalization process theory analysis.

Area of Science:

• Health Services Research
• Implementation Science
• Primary Care Medicine

Background:

• Care management in primary care is vital for chronic disease patients but faces implementation challenges.
• Different care management structures impact implementation success.
• Normalization Process Theory (NPT) aids understanding of intervention routine integration.

Purpose of the Study:

• To use NPT to analyze how care management structure influences its routine integration into primary care practices.
• To identify factors contributing to successful implementation of care management programs.

Main Methods:

• Qualitative study involving 70 semi-structured interviews and 25 observations across 25 practices in Michigan.
• Practices were selected for variation in physician organizations, care management type, and normalization degree.
• Data analysis utilized editing and template approaches guided by NPT.

Main Results:

• Two care management structures emerged: practice-based (embedded) and centralized (external).
• Practice-based care management demonstrated better normalization than centralized models.
• NPT constructs, particularly collective action, explained normalization differences, highlighting the importance of communication, skills, and organizational support for relational integration.

Conclusions:

• Successful implementation of complex care management interventions in primary care is achievable.
• NPT provides valuable insights for explaining and addressing implementation variations in new care management programs.
• Optimizing communication, skills, and organizational support is crucial for effective care management integration.