Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review

Yeoh, Eng‐Kiong; Wong, Martin Cs; Wong, Eliza Lai Yi; Yam, Carrie Ho Kwan; Poon, Chin Man; Chung, Roger Yat‐Nork; Chong, Ka Chun; Fang, Yuan; Wang, Haoxiang; Liang, Miaoyin; Cheung, Wai W.; Chan, Chun Hei; Zee, Benny; Coats, Andrew J.S.

doi:10.1016/j.ijcard.2017.11.057

Cited by 81 publications

(83 citation statements)

References 49 publications

(121 reference statements)

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“…A lack of robust intervention research in the CDM field is, unfortunately, not uncommon. Reviews36 37 examining feasibility and acceptability of CDM interventions in primary care identified persistent concerns with studies’ methodological rigour and ongoing sustainability. Among the included studies, the majority were published in the last 10 years within the USA.…”

Section: Discussionmentioning

confidence: 99%

Chronic disease management models in nursing homes: a scoping review

et al. 2020

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ObjectivesNursing home (NH) residents experience a high burden of chronic disease. Chronic disease management (CDM) can be a challenge, as the context of care provision and the way care is provided impact care delivery. This scoping review aimed to identify types of chronic diseases studied in intervention studies in NHs, influential contextual factors addressed by interventions and future CDM research considerations.DesignThe scoping review followed guidelines by Arksey and O’Malley (2005) and Levac, Colquhoun and O’Brien (2010). Six reviewers screened citations for inclusion. Data extraction was performed by one reviewer and verified by a second reviewer.Data sourcesWe searched four databases: CINAHL, EMBASE, PubMed and Scopus, in March 2018.Eligibility criteriaStudies were included if (1) aim of intervention was to improve CDM, (2) intervention incorporated the chronic care model (CCM), (3) included NH residents, (4) analysed the efficacy of the intervention and (5) sample included adults over age 65 years. Studies were limited to English or French language and to those published after 1996, when the CCM was first conceptualised.Data extraction and synthesisExtracted information included the type of chronic disease, the type and number of CCM model components used in the intervention, the method of delivery of the intervention, and outcomes.ResultsOn completion of the review of 11 917 citations, 13 studies were included. Most interventions targeted residents living with dementia. There was significant heterogeneity noted among designs, outcomes, and type and complexity of intervention components. There was little evaluation of the sustainability of interventions, including feasibility.ConclusionsResearch was heavily focused on management of dementia. The most commonly included CCM components were multidisciplinary care, evidence-based care, coordinated care and clinical information systems. Future research should include subjective and objective outcomes, which are meaningful for NH residents, for common chronic diseases.

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Section: Discussionmentioning

confidence: 99%

Chronic disease management models in nursing homes: a scoping review

et al. 2020

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“…A meta-regression on interventions designed to improve outpatient care of T2DM patients revealed that case management and team changes were associated with the largest pooled reductions in HbA1c values [54]. As disintegrated care originating from HCPs working in isolation and insufficient knowledge of HCPs was identified as a severe limitation of the original CCM [55], we include case and care management delivered by experienced HCPs in our model.…”

Section: Targeted Interactionmentioning

confidence: 99%

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

Timpel

Lang²,

Wens

et al. 2020

Int J Integr Care

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BackgroundA growing number of EU citizens suffers from diabetes, posing an emerging health, social and economic burden in the EU [1]. This burden is mostly driven by type 2 diabetes mellitus (T2DM), which is increasingly diagnosed at younger age and leads to a rising number of adults with T2DM aged 65 and older [1]. Due to these rising numbers in diabetes prevalence a growing number of patients faces accompanying comorbidities as well as complex needs [2][3][4][5]. However, many care systems are historically built on separate sectors (health vs. social care, in-vs. outpatient care). This traditional acute and episodic focus of care is inadequate to effectively meet the complex needs of patients as it increases the risk of care fragmentation and loss of information [6,7]. Although these circumstances are repetitively part of health policy initiatives [8,9], there is still an institutional and regulatory separation between health and social care services, as well as between ambulatory and inpatient care [10].Integrated care is said to improve outcomes of care by linking services of providers along the continuum of care and thus overcoming issues of fragmentation [11]. Back in 1996, Ed Wagner developed the Chronic Care Model (CCM), which became a cornerstone to improve care delivery for chronically ill patients. The CCM comprises the following six components: (1) community, (2) health system, (3) self-management support, (4) delivery system design, (5) decision support and (6) clinical information systems [12]. Ever since, different initiatives developed new models targeting specific weaknesses of the initial CCM.However, recent analysis uncovered that the understanding of established models' impact on chronic disease management is limited [13]. This is especially true for the effectiveness and applicability of chronic care models in different populations and settings [13]. Additionally, on behalf of the MANAGE CARE Study Group Background: Most current care models are disease-or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. Method: An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model. Results: The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care. Conclusion: The MANAGE CARE MODEL provides...

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“…However, the effect of each independent component embedded in the CCM (community, health system, self‐management support, delivery system design, decision support, and clinical information systems) has not shown definite benefits on cardiovascular risk reduction . A systematic review found that among 25 CCM‐based studies, the proportion of patients who reached desired cardiovascular risk factor targets ranged from 1.8% to 28% for A1C, 3.8% to 45% for blood pressure reduction, and 3.2% to 58% for optimal lipid control …”

Section: Implementation Strategies To Improve Preventive Care In Patimentioning

confidence: 99%

“…40,41 A systematic review found that among 25 CCM-based studies, the proportion of patients who reached desired cardiovascular risk factor targets ranged from 1.8% to 28% for A1C, 3.8% to 45% for blood pressure reduction, and 3.2% to 58% for optimal lipid control. 42 Clinical decision support and framework-based interventions seem to address provider and system-level barriers to managing patients with T2D and CVD. However, their effect is unclear and future studies should focus on investigating clinical endpoints and improving workflow integration and sustainability.…”

Section: Framework-based Interventionsmentioning

confidence: 99%

Opportunities for improving use of evidence‐based therapy in patients with type 2 diabetes and cardiovascular disease

Gao

Peterson

Pagidipati

2019

Clinical Cardiology

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Evidence‐based therapy that target hyperlipidemia, hypertension, smoking cessation, and weight loss have demonstrated significant benefits in reducing cardiovascular risks and related events. Although the benefit of intensively lowering blood glucose is unclear, newer antidiabetic drugs (glucagon‐like peptide‐1 receptor agonists and sodium‐glucose cotransporter‐2 inhibitors) have shown cardiovascular benefits in addition to their antihyperglycemic effect. Yet, studies suggest that recent use of evidence‐based therapy and management of cardiovascular risk among individuals with type 2 diabetes (T2D) and cardiovascular disease (CVD) remains largely suboptimal. The following narrative review first identifies barriers to translating research evidence to clinical practice at the levels of provider, health system, patient, and cost. Then it synthesizes previous implementation strategies that addressed multifaceted barriers and attempted to improve care for patients with T2D and CVD. In conclusion, team‐based care coordination, reminding systems in combination to pharmacist consultation and patient education, provider education compatible with clinical workflow, and coupled incentives between providers and patients appeared to be effective in reducing cardiovascular risks for patients with T2D and CVD, though the scalability and long‐term clinical effect of these strategies as well as the possibility of interventions involving payers and health systems remain uncertain.

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Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review

Cited by 81 publications

References 49 publications

Chronic disease management models in nursing homes: a scoping review

Chronic disease management models in nursing homes: a scoping review

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

Opportunities for improving use of evidence‐based therapy in patients with type 2 diabetes and cardiovascular disease

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