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@ShahidNShah
@ShahidNShah
Key Components of Chronic Care Management Programs: Qualitative Descriptions of Care Managers’ Practice
Increasing numbers of people live with chronic conditions. Yet, healthcare systems are often designed based on an acute care model that is not well-aligned with the needs of patients with chronic conditions, resulting in poor patient outcomes and high healthcare costs. To better assist patients living with chronic conditions, there is an urgent need to develop chronic care management models that are effective, scalable, and financially sustainable. The aim of this study was to identify and describe key components of chronic care management practice as a foundation to develop such a program.
Medigy Insights
Effective chronic care management in community settings relies on five core components—whole-person assessment, patient-centered care planning, direct care support, care coordination, and ongoing monitoring—which together help nurses tailor care to patients’ complex needs beyond specific diagnoses.
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