Chronic Care Model Improves VA Care, with Opportunities for More Progress within and Outside VA
- The return on VA's investment in the Chronic Care Model (CCM) is reflected in significant improvements in quality of care. Comparisons of the quality of chronic illness and preventive care between VA and the private sector generally show that VA provides superior quality of care.
- Looking ahead, the American Recovery and Reinvestment Act (ARRA) contains several provisions with the potential to support the widespread adoption of CCM processes throughout the US healthcare system. For example, the ARRA includes $1.1 billion for comparative effectiveness research that may expand the evidence base for practice guidelines and best practices for implementation. It also includes $19.2 billion for the enhancement of electronic health records.
- Adopting components of the CCM can transform a healthcare system, but challenges remain. The authors suggest further research in several areas, such as defining a benchmark that is associated with improved CCM processes and outcomes of care, and developing strategies that improve the implementation of the Chronic Care Model in smaller physician practices.
In 1998, the chronic care model (CCM) was introduced. The CCM proposed that optimal care for patients with chronic illness requires healthcare systems that: have connections to community resources, provide self-management support, are organized around integrated teams, use tools to support evidence-based guidelines, and include enhanced clinical information systems (e.g., electronic health records). Since then, the CCM has been embraced by many healthcare systems including VA, whose reorganization in 1995 encouraged the type of organizational commitment that the CCM views as vital to providing high quality care for patients with chronic illness. For example, VA instituted the Computerized Patient Record System (CPRS), one of the most advanced electronic health record systems in the U.S. VA also developed the Quality Enhancement Research Initiative (QUERI), which uses evidence-based research to rapidly translate innovations into practices that improve the processes and outcomes of care, particularly for chronic conditions such as heart disease and diabetes. VA is an ideal environment for the CCM, and it has used this quality improvement model to advance health care for Veterans.
Drs. Jackson and Weinberger are part of HSR&D's Center for Health Services in Primary Care located in Durham, NC.
Jackson G and Weinberger M. A Decade with the Chronic Care Model: Some Progress and Opportunity for More. Medical Care Commentary, September 2009;47(9):929-931.