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Public Policy and Administration


Hilda Shepeard


Management of chronic disease requires a different service delivery model from that of acute illness. The uninsured population experience poorer health status and increased incidence of chronic disease than do the insured population. The purpose of this study was to identify the supports and barriers present in providing chronic disease management to patients at Ohio free clinics. Wagner's theory of chronic disease management served as the theoretical lens. The sequential, exploratory mixed methods study collected data from 13 free clinics belonging to the Ohio Association of Free Clinics (OAFC). Quantitative questions focused on processes in clinics with high and low fidelity to the chronic care model (CCM) determined by the Assessment of Chronic Illness Care (ACIC) survey. A backwards stepwise logistic regression was used. The quantitative analysis determined the 3 highest and lowest scoring clinics on the ACIC survey who then participated in a 2 tiered multi-case study series. Qualitative questions examined supports present in high fidelity clinics and barriers present in clinics with low fidelity. Qualitative findings identified 5 support areas that centered on progressive vision and patient-centered care themes that existed in high fidelity clinics. Four barriers were identified in low fidelity clinics that focused on the theme of capacity building. These findings provide evidence to guide the OAFC's work in improving adherence to the CCM constructs, thereby elevating the quality of care to the uninsured with chronic disease to the level of those providers governed by accrediting organizations. Changes in quality of care may result in an improvement to the health status of the individual and the communities in which they live.