[Development of an instrument for the assessment of chronic care models].

OBJECTIVE: To present the context, aim and process of designing the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]), which was developed to make the conceptual framework of the chronic care model operational in the Spanish national health system.
METHODS: The IEMAC was developed by a series of national experts with distinct profiles of expertise using qualitative research techniques. A matrix was built with the dimensions selected as basic for the new model. In each dimension, actions were identified and categorized, creating a taxonomy of components and interventions. The clarity and appropriateness of each intervention, and the degree of evidence to support it, were assessed. The resulting questionnaire was validated by other experts from diverse disciplines and settings. Finally, the IEMAC 1.0 was piloted at macro, meso and micro levels.
RESULTS: The IEMAC is a tool to be self-administered by health organizations at macro, meso and micro levels. This instrument is composed of six dimensions, 27 components and 80 interventions, whose implementation is assessed with the aid of a scale that combines deployment, systematic evaluation, and orientation improvement. The IEMAC uses a systemic, population-based approach and integrates promotion, prevention, and coordination with social services.
CONCLUSIONS: The IEMAC contains a set of interventions that can be used as a road map by decision makers, managers and clinicians interested in building a state-of-the-art chronic care model. At the same time, the IEMAC allows healthcare organizations to identify their baseline score and the progress achieved after improvement interventions.