Incorporating the Chronic Care Model to Improve Health Outcomes and Satisfaction

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.