Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Chris L. S. Coryn

Second Advisor

Dr. Daniela Schröter

Third Advisor

Dr. Mark Ivey


Meta-evaluation, chronic care model, implementation science


Background: The purpose of this dissertation is to explore the use of metaevaluation to evaluate the quality of healthcare studies conducted on programs that employ the Chronic Care Model (CCM) to provide chronic illness care. In this study, healthcare studies of CCM programs are regarded as program evaluations. Method: Using a non-experimental cross-sectional design, 28 healthcare studies of CCM programs were evaluated using the accuracy standards portion of the Program Evaluations Metaevaluation Checklist (Stufflebeam, 2011). The results of the metaevaluations were analyzed and compared to the HEAL grade of the same healthcare studies as determined by the Hierarchy of Evidence and Appraisal of Limitations grading system (Gugiu, et al, 2013). Results: When the quality of the 28 healthcare studies were evaluated by metaevaluation, only five (5) studies rated Good. The rest of the studies are rated either Fair (20) or Poor (3). When the quality of the same healthcare studies were assessed by the HEAL grading system, only four (4) studies received an A or A- and only four (4) studies received a B or B-. The rest of the studies received either a C- (2) or a D (18). Also, none of the metaevaluation ratings of the 28 healthcare studies showed a significant relationship with the HEAL scores of the same healthcare studies. Conclusions: Whether rated by the accuracy metaevaluation checklist or graded by the HEAL grading system, the selected CCM studies were mostly of poor to fair quality. This finding raises the level of urgency for improving the study quality of evidence-based medicine. Also, the lack of significant relationship between the two measures of study quality may indicate that the two instruments are complementary rather than substitutionary. If so, it may be better to use both the metaevaluation ratings and the HEAL scores to determine study quality rather than using one instrument over the other.

Access Setting

Dissertation-Open Access