The Chronic Care Model

One of the key elements of the Chronic Care Model (CCM) is self-management support. The World Health Organization recommends the application of this model to all chronic conditions.⁽¹⁾ It is developed around a collaborative approach to chronic conditions, where patients are encouraged to participate fully as partners in the provision of their own care.

The CCM was developed by Wagner⁽²⁾ at the MacColl Institute for Healthcare Innovation using the best from research and practice to offer a collaborative program for the chronically ill. The model identifies key elements of a health care system that encourage high-quality chronic disease care, as can be seen in Figure CCM. The model can be applied to a range of chronic illnesses, different health care settings and target populations.

The results from research using the CCM are healthier patients, more satisfied providers, and cost savings.⁽³⁾ The CCM has been successfully applied and implemented into a wide range of health care settings and organisations⁽⁴⁾ and is being continually revised and refined.

Further information on this model can be found at http://www.improvingchroniccare.org/.

Figure CCM: This figure has been used with permission from Edward H. Wagner, MD, MPH, Chronic Disease Management: What Will It Take To Improve Care for Chronic Illness? Effective Clinical Practice, Aug/Sept 1998, Vol 1.⁽¹⁾

References

1. World Health Organization. Innovative care for chronic diseases. Building blocks for action. 2002; Geneva.
2. Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4.
3. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. 2002 Oct 16;288(15):1909–14.
4. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. 2002 Oct 9;288(14):1775–9.