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Chronic Care
Description Background Chronic Care Model
Ed Wagner's Chronic Care Model The Community The Health System Self-Management Support Delivery System Design Clinical Information Systems & Decision Support
Healthcare Policy Integrating Treatment in Primary Care (ITPC) EHR Demo
  
 
Home / Initiatives / Chronic Care / Chronic Care Model / Delivery System Design

Delivery System Design

Examples of gaps and weaknesses in our current acute care system

Patients usually initiate contact with physicians, which means they come in for acute problems, not ongoing disease management or preventive services.

Care depends primarily on the individual office visit.

Office visits revolve primarily around the physician who has an average of only 12-15 minutes per visit.

 

 

Examples of implementations of the chronic care model
(these are illustrations and not necessarily prescriptions or endorsements)

Provider organizations have systems for reaching out to patients due for disease management visits and preventive services.

Care is flexible and can include, phone, e-mail, group visits, etc.

Office visits are planned and involve an integrated care team with clearly defined roles.

 

 

 

 

 

 

 

 

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