Self-management support is an important component of chronic care delivery. Sequist and colleagues sought to validate a measure of self-management support and to characterize performance, including comparisons across chronic conditions. They incorporated a new question module for self-management support within an existing annual statewide patient survey process in 2007. The survey identified 80,597 patients with a chronic illness on whom the new measure could be evaluated, and compared with patients' experiences on four existing measures (quality of clinical interactions, coordination of care, organizational access, and office staff). Spearman correlation coefficients were calculated for self-management support scores for individual chronic conditions within each medical group. Multivariable logistic regression models were fit to identify predictors of more favorable performance on self-management support. Composite scores of patient care experiences, including quality of clinical interactions (89.2), coordination of care (77.6), organizational access (76.3), and office staff (85.8) were higher than for the self-management support composite score (69.9). Self-management support scores were highest for patients with cancer (73.0) and lowest for patients with hypertension (67.5). The minimum sample size required for medical groups to provide a reliable estimate of self-management support was 199. There was no consistent correlation between self-management support scores for individual chronic conditions within medical groups. Increased involvement of additional members of the healthcare team was associated with higher self-management support scores across all chronic conditions.

WHAT THE STUDY COULD MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that measurement of self-management support is feasible and can identify gaps in care not currently included in standard measures of patient care experiences.

WHAT THE STUDY COULD MEAN TO YOU AS A PATIENT: The last sentence is likely the most important in the study: It is imperative that other members of a treatment team be involved in the self-management of any chronic conditions. You not only need medical personnel, but team members who are more fully knowledgeable about self-management processes, how they are taught, and applied by patients.

TD Sequist et al. Statewide Evaluation of Measuring Physician Delivery of Self-Management Support in Chronic Disease Care. Journal of General Internal Medicine, June 9, 2009.