UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS:The goal of the chronic care model is not to manage a disease but to change how daily care is delivered by clinical teams
The goal of the chronic care model is not to manage a disease but to change how daily care is delivered by clinical teams (Coleman et al., 2009). Instead of reacting to changes in the patient’s condition, the team provides proactive interventions. The model is systematic and re- quires six components. They are:
● Self-management support ● Decision support ● Delivery system design ● Clinical information systems ● Health care organization ● Community resources
Given that the population is aging and chronic conditions are expected to rise, the chronic care model is an appropriate one to consider for providing care to patients with chronic illnesses.
No delivery system is perfect. Or permanent. As health care adapts to changes in reimbursement, demands for quality, and technological advances, models for delivering care will continue to evolve.
What You Know Now • Nursing care delivery systems provide a structure for nursing care. Most organizations use a combina-
tion of nursing care delivery systems or modify one or more systems to meet their own needs. • Traditional care models include functional nursing, team nursing, total patient care, and primary nursing. • Integrated models of care include practice partnerships, case management, critical pathways, and differen-
tiated practice. • Evolving models of care include patient-centered care, a synergy model of care, clinical microsystems,
and a chronic care model. • Commonly used by Magnet-certified hospitals, the patient-centered care model provides care from admit-
ting to discharge on the unit. • The synergy model, developed by the American Association of Critical Care Nurses, matches patients’
characteristics with nurses’ competencies. • Clinical microsystems use a structure that puts decision making in small units of those who provide the care. • The chronic care model is a systemwide, proactive model designed to provide daily care to patients by
clinical teams. • As health care adapts to changes in reimbursement, demands for quality, and technological advances,
models for delivering care will continue to evolve.