Assessment of Clinical Care Resources and Supports for self-management (CCRS)

The CCRS has been adapted from the Assessment of Primary Care Resources and Supports for Chronic Disease Self-management (PCRS) to meet the needs of psychiatrists. It was developed by the Advancing Diabetes Self-management Program of the Robert Wood Johnson Foundation to assess the quality of self-management support. The research supports the use of this tool and associated processes with other chronic conditions.⁽¹⁾

It can be used to:

• provide self-assessment and feedback and serve as a quality improvement tool to help build consensus for change
• identify optimal performance of providers and systems as well as gaps in resources, services and supports
• integrate changes into support team systems by identifying areas where self-management support is needed.⁽¹⁾

Best results are achieved by working in multidisciplinary teams. Expected outcomes include enhanced patient and staff abilities in self-management processes, as well as improved clinical and behavioural outcomes for patients.

The recommendation is that the tool be used on a regular basis, for example quarterly, to monitor improvement and to guide self-management support into the health care systems.⁽¹⁾

It is consistent with current best practices in quality improvement and chronic illness care and can be applied across a range of work settings and chronic conditions.

A copy of the CCRS survey is attached. Click to view CCRS.pdf

The components of the CCRS

The key components of the CCRS are patient support and organisational support.⁽²⁾

• Patient support: an assessment of the patient, provider and care team

-       individualised assessment of patient’s self-management educational needs

-       patient self-management education

-       goal setting and action planning

-       problem-solving skills

-       emotional health

-       patient involvement

-       patient social support

-       linking to community resources

• Organisational support: an examination of the characteristics of organisational support for self-management⁽³⁾

-       continuity of care

-       coordination of referrals

-       ongoing quality improvement

-       documentation of self-management support services

-       patient input

-       integration of self-management support into clinical care

-       patient care team

-       staff training and education

The improvement process using the CCRS

References

1. Available from http://www.diabetesinitiative.org
2. Diabetes Initiative. Introduction to the PCRS. Washington University in St Louis School of Medicine, 2009. Available from http://www.diabetesinitiative.org/support/documents/PCRSoverviewpresentation_000.pdf
3. Shetty G, Brownson CA. Characteristics of organizational resources and supports for self management in primary care. The Diabetes Education 2007;33(Suppl 6):185S–92S.