The eHealth Enhanced Chronic Care Model: A Theory Derivation Approach

Abstract

BackgroundChronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools.ObjectiveThe first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses.MethodsUsing Theory Derivation processes, we identified a “parent theory”, the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms “CCM or Chronic Care Model” AND “eHealth” or the specific identified components of eHealth. Additionally, “Chronic Illness Self-management support” AND “Technology” AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM.ResultsWe identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider.ConclusionsThe revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.

Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study (Preprint)

“…Model (eCCM) The eCCM [22] guided the development of our mHealth intervention protocol and was used to evaluate feasibility. eCCM explains how adults with chronic diseases become active, educated, engaged, and empowered while working with their healthcare providers, community, and social networks in actual and virtual communities as well as healthcare systems [22].…”

“…eCCM explains how adults with chronic diseases become active, educated, engaged, and empowered while working with their healthcare providers, community, and social networks in actual and virtual communities as well as healthcare systems [22]. Since current care of chronic diseases for Korean adults is highly centered on acute care settings, our mHealth strategies encouraged those living in the community to enhance their integrative knowledge and practice of self-management when dealing with chronic diseases.…”

The health information national trends survey (HINTS): A resource for consumer engagement and health communication research

“…1, we present an enhanced version of the Chronic Care Model as developed by Gee and colleagues [14] to illustrate how the post-HITECH (i.e., the Health Information Technology for Economic and Clinical Care Act of 2009) healthcare system can be engineered to support patient engagement and to compensate for deficits in health literacy. The updated model adds in components of technology-mediated communication and support typical of today's healthcare settings [8,14].…”

How do the design features of health hackathons contribute to participatory medicine?

“…as active participants in data collection and decision making about their own health. This is more than the relationship implied in the CCM, of proactive providers and informed responsive patients (Gee et al, 2015;Wagner et al, 2002). It extends the patient-clinician relationship from productive interactions to incorporate activities outside the clinician's workplace, e.g.…”

“…The CCM claims that effective care is based on 'productive interactions' between the people providing care and those needing and accessing it. Widespread use of this model has demonstrated improvements in the health of people with long term health issues (Gee, Greenwood, Paterniti, Ward, & Miller, 2015;Stellefson, 2013). The model has been adjusted to incorporate ehealth components (Gee et al, 2015).…”