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As outlined in the
Chronic Care Model, there are several types of practice changes
that can influence effective chronic illness interventions.
- Practice
re-design
- This focuses on increasing roles and responsibilities of the
practice team, with an emphasis on patient follow-up and use
of alternative mechanisms (e.g. group visits; drop-in medical
group appointments) to increase the efficiency of care.
- Self-management
support
- Since patients are an integral part of care, they must be
offered training and provided with ongoing support to proactively
manage the day-to-day complications of their condition.
- Clinical
information systems
- Clinical information systems or registries are essential for
tracking the care and outcomes of an entire population of patients,
as well as for prompting providers about follow-up.
- Decision
support
- Decision support involves, for example, access to guidelines
or joint visits involving primary care providers and specialists.
- Community
resources
- Links to key community resources facilitate the delivery of
care to a larger population of patients and individuals in the
community, and may enhance self-management delivery.
- Leadership
- In order for all the elements of care to take effect, strong
support from leadership within a health care organization is
needed. The Malcolm Baldrige National Quality Award Criteria,
the standard for organizational excellence in other industries,
include leadership as a central component of effective organizations
(US Chamber of
Commerce, 1993). Shortell
and colleagues (1995) have adapted these criteria
to health care organizations and have reported the need for
support from senior leadership in making health care system
changes.
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