Abstract
BackgroundWagner’s Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease. Given the high prevalence of chronic illness in older persons, these frameworks can play a valuable role in reorienting the health care system to better serve the needs of seniors. We aimed to identify and assess the measured goals of E/CCM interventions in older populations. In particular, our objective was to determine the extent to which published E/CCM initiatives were evaluated based on population, community, system and individual-level outcomes (including clinical, functional and quality of life measures).MethodsWe conducted a systematic search of the Science Citation Index Web of Knowledge search tool to gather articles published between January 2003 and July 2014. We included published CCM interventions that cited at least one of the fundamental papers that introduced and described the CCM and ECCM. Studies retained for review reported evaluations of senior-focused E/CCM initiatives in community-based settings, with the topic of “older adults” OR senior* OR elder* OR geriatric OR aged. The resulting 619 published articles were independently reviewed for inclusion by two researchers. We excluded the following: systematic reviews, meta-analyses, descriptions of proposed programs, and studies whose populations did not focus on seniors.ResultsWe identified 14 articles that met inclusion criteria. Studies used a wide range of measures, with little consensus between studies. All of the included studies used the original CCM. While a range of system-level and individual patient outcomes have been used to evaluate CCM interventions, no studies employed measures of population or community health outcomes.ConclusionsFuture efforts to test E/CCM interventions with seniors would be aided by more consistent outcome measures, greater attention to outcomes for the caregivers of older persons with chronic illness, and a greater focus on population and community impacts.
Highlights
Wagner’s Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease
We were interested in understanding the outcomes and indicators used to evaluate expanded versions of the Chronic Care Model (E/CCM) interventions that focus on older adults with chronic illness
Seven studies [11,12,13, 17, 18, 21, 22] examined healthrelated quality of life through health status, quality of Discussion Many published studies of E/CCM interventions lack detailed descriptions of the interventions evaluated and the study context, making it difficult to determine how closely the interventions correspond with the E/CCM frameworks
Summary
Wagner’s Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease. Given the high prevalence of chronic illness in older persons, these frameworks can play a valuable role in reorienting the health care system to better serve the needs of seniors. Our objective was to determine the extent to which published E/CCM initiatives were evaluated based on population, community, system and individual-level outcomes (including clinical, functional and quality of life measures). Health care systems are frequently challenged by issues of access, continuity, fragmentation and quality of care in addressing the needs of older persons with chronic illness [1]. Wagner and colleagues [2] developed the Chronic Care Model (CCM) as a framework for the development of more comprehensive and integrated chronic care. The CCM framework includes six components: Community Resources and Policies; Health system organization; SelfManagement Support; Decision Support; Delivery System
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