Chronic illnesses impose a significant burden on individuals, families, communities, and the health care system. Diseases, such as asthma, chronic lung disease, coronary artery disease, heart failure, diabetes, hypertension, HIV, and chronic depression result in disabling symptoms, loss of functional ability and productivity. Chronic illnesses cost billions of dollars each year in both direct medical costs and indirect impact on work productivity, drain family and community resources, and overburden the health care system. The ability of the U.S. health care system to respond to the crisis of the rising prevalence of chronic diseases is limited by its current focus on acute illness, with care delivered in response to illness in crisis rather than proactive management. This reactive mode of health care delivery has been called the "tyranny of the acute" with few resources devoted to proactively managing chronic illness and preventing exacerbations.
Since many chronic diseases are directly linked to behaviors (e.g., tobacco use, sedentary lifestyle, and unsafe sexual behaviors) and environmental exposures, the course of illness can be modified with planned interventions. A model for chronic illness management, implemented at the system level, was proposed by Wagner et al. and is described in detail in two articles which provide insight into how chronic illness can be effectively managed in primary care (see "Suggested Readings," below). The Chronic Care Model (CCM) incorporates the community, health care system, health care team of providers, and patients in a unified model designed to improve patient outcomes for those with chronic illnesses. The model includes six components or dimensions of care within the health care system that are necessary to maximize effective use of resources and coordinate care. Briefly, the six components include: (1) community resources and policies, (2) the health care organization, (3) self-management support, (4) delivery system design, (5) decision support, and (6) clinical information systems. The last four components exist within the health care organization in an integrated systems model of care. Implementation of this system of care, with linkages to community resources, provides a network of support for a knowledgeable, prepared health care team to work with patients in partnership to manage and control chronic diseases. The CCM suggests a complete redesign of primary care practice to accomplish the goals of chronic illness management.
The Community: Resources & Policies
The health care organization exists within a local community where individuals with chronic illnesses live. An integral component of the CCM is the cultivation and maintenance of relationships with community resources and agencies. Many organizations in the community provide additional resources and support for individuals with chronic illnesses, such as patient education classes, exercise classes, smoking cessation programs, and home health services. Identifying the relevant resources in the community and facilitating referrals are valuable actions for optimal patient care because they can fill gaps in needed services.
The foundation of the CCM rests on the attitudes ...