Reviewing the Effectiveness of Chronic Care Models

There is an association between the implementation of chronic care model (CCM) elements and improvements with healthcare practice or health outcomes for people with chronic disease, according to a literature review of papers. The study was published in BMC Health Services Research.

Chronic diseases are prevalent in both developed and developing nations, and 63% of deaths in 2008 were a direct result of chronic diseases. Cardiovascular disease, diabetes, cancer, and chronic respiratory disease being the main culprits.

The investigators included 77 papers in the review, and the majority reported improvements to healthcare practice or health outcomes. Only 2 papers reported a decline in health outcomes measured after implementing CCM elements, and 1 paper suggested an association between the implementation of CCM elements and a decline in healthcare practices.

Studies included in the review had to have implemented at least 2 of the following 8 CCM elements:

1. Facilitated community support to meet the needs of patients
2. Facilitated unpaid/informal family support to meet the needs of patients
3. Self-management support to meet the needs of patients
4. Health system improvement to meet the needs of healthcare providers
5. Delivery system design to meet the needs of healthcare providers
6. Enhanced healthcare professional case management support to meet the needs of patients
7. Decision support to meet the needs of healthcare providers
8. Clinical information systems to meet the needs of healthcare providers

However, the variability among the studies in the combination of and ways in which CCM elements were implemented made it impossible for the researchers to identify any optimal combination of the 8 CCM elements that could improve either healthcare practice or health outcomes.

The results of the study may suggest that factors in addition to CCM implementation may have played a role in improvements, according to the paper.

“Although not specifically addressed by papers in this review, spending the time and resources to develop and implement a CCM may have also underpinned both healthcare practice and health outcome improvements by signaling to staff that improving chronic disease care was a priority for their healthcare service,” the authors suggested.

Other factors may have been providing a collegial environment that supports reflective practice, which sends a clear message about the importance of chronic disease care, and ensuring leaders support the implementation and sustainability of a new CCM.

“Given the high prevalence of chronic disease in disadvantaged populations including Indigenous communities, elements including [family support] could play a greater role in improving the management of and outcomes from chronic disease for these peoples,” the authors concluded.