Section outline

  • Applying the Chronic Care Model (Part 1)

    Welcome to Module 2. In this module, we will introduce you to the course and provide you with a brief overview of the current state of the healthcare system. We will also discuss non-communicable diseases (both globally and chronic disease in Jamaica, including the burden as well as policies and programmes) and introduce you to the Chronic Care Model.

    The Chronic Care Model identifies essential elements of a health care system that encourage high-quality chronic disease care: the community; the health system; self- management support; delivery system design; decision support, and clinical information systems. Within each of these elements, there are specific concepts (Change Concepts) that teams use to direct their improvement efforts. Change concepts are the principles by which care redesign processes are guided.
    Source: Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2-4. (The Chronic Care Model image first appeared in its current format in this article.)

    Learning Objectives

    Upon completion of this module, you will be able to:

    • Define health system organizations;
    • Analyze the delivery system design change concepts in the CCM;
    • Investigate decision support change concepts within the CCM;
    • Explore clinical information systems change concepts within the CCM;
    • Define the core principles of patient-centered care; and
    • Identify common barriers to implementing the CCM.