Abstract
Background: There remains a gap in evidence on how to support the implementation of effective integrated chronic disease management programs. We developed a 10-mechanism framework based on a decade of empirical findings, to support progressive implementation (scale, spread, and sustainability). The purpose of this study was to augment the framework to include sustainability and validate the framework for use in practice.
Approach: A modified Delphi approach was employed and consisted of 3 rounds, 2 surveys and 1 focus group. Implementation science experts from around the world were invited to answer an 83-item questionnaire to provide a deeper understanding on the clarity, relevance, and importance of statements regarding mechanism constructs and definitions of the conceptual framework. A concurrent evaluation of sustainability of a chronic disease management program also occurred; findings informed refinement of the framework.
Results: 21 panel experts were invited, with 18 participating at different stages. In the first round, agreement was reached on 67 out of 83 items, establishing the importance and relevance of definitions. However, it highlighted the need for clearer definitions regarding mechanisms. In the second round, consensus was achieved on the remaining 16 items related to these mechanisms. During this round, an analysis of sustainability data identified a new mechanism that should be included in the framework. The research team recognized the need for a focus group to clarify the concept of sustainability and its alignment within the framework. Consensus was ultimately reached on the addition and definition of "alignment," leading to a new framework with a total of 11 mechanisms.
Implications: This framework is firmly rooted in empirical research while adapting to the evolving landscape of healthcare implementation. By using this framework, healthcare professionals can gain powerful insights into the strategic approaches essential for successfully implementing and sustaining COPD management in primary care. This framework can guide the development of disease management programs for other chronic conditions, such as congestive heart failure and diabetes, paving the way for a comprehensive, cohesive, and sustainable approach to chronic disease management across the healthcare continuum.