Chronic Care Model
The Chronic Care Model, developed by the MacColl Institute
for Healthcare Innovation creates greater opportunity for
the clinician to provide the best care to his or her patient
and empowers the patient to assume greater responsibility
for managing their health. The model was designed to work
in large medical groups, clinics and health systems. We will
have the opportunity to adapt this model to smaller offices
where the systems are not always robust in their ability to
track and manage care. We will also be bringing in the community
resources as a key component of team based care. For these
offices, the team often resides in the community.
Five new themes have been incorporated into the model. These
include Patient Safety (in Health System); Cultural competency
(in Delivery System Design); Care coordination (in Health
System and Clinical Information Systems): Community policies
(in Community Resources and Policies); and Case management
(in Delivery System Design).
- Guide to Implementing the
Chronic Care Model
American Academy of Family Physicians 2007
- Improving Chronic Illness
Care: Lessons Learned from Private Practice
Family Practice Management November/December 2005
- Translating the Chronic
Care Model into the Community
Diabetes Care April 2006
- Improving Chronic Illness
Care Model Elements
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