Table 1 Overview of the definitions of the elements of the Chronic Care Model (CCM) [27]
Health organization | “Create a culture, organization and mechanisms that promote safe, high quality care” |
Decision support | “Promote clinical care that is consistent with scientific evidence and patient preferences” |
Delivery system design | “Assure the delivery of effective, efficient clinical care and self-management support” |
Clinical information system | “Organize patient and population data to facilitate efficient and effective care” |
Self-management support | “Empower and prepare patients to manage their health and health care” |
Community | “Mobilize community resources to meet needs of patients” |