Incorporating the Chronic Care Model to Improve Health Outcomes and Satisfaction

Saturday, 7 November 2015

Marcia A. Potter, MSN, RN, FNP
School of Nursing, Chamberlain College of Nursing, Downers Grove, IL, USA
Jill S. Walsh, DNP, MS, CEN
Chamberlain College of Nursing, Downers Grove, IL, USA

Patient activation and engagement can be powerful enablers for health outcomes; just as important are staff engagement and satisfaction.   This author re-designed clinic templates to accommodate a time-based element of longitudinal care and implemented skill-based competencies to provide collaborative, team-based care to patients with type 2 diabetes.  Seventy adults with diabetes and 6 staff members caring for them participated in a 12 week process improvement project utilizing the Chronic Care Model to link satisfaction and health outcomes.  Patients completed satisfaction surveys at the end of their clinical encounters; staff completed satisfaction surveys pre- and post-implementation. The authors analyzed hemoglobin A1C levels pre- and post- implementation.  As engagement and activation increased for both staff and patients, hemoglobin A1C levels decreased.  Clinical implications include broad application of the CCM to daily practice, improved self-efficacy, healthier populations, and health care cost reductions.