Improving chronic illness care: Translating evidence into action

The growing number of persons suffering from major chronic illnesses face m any obstacles in coping with their condition, not least of which is medical care that often does not meet their needs for effective clinical managemen t, psychological support, and information. The primary reason for this may be the mismatch between their needs and care delivery systems largely desig ned for acute illness. Evidence of effective system changes that improve ch ronic care is mounting. We have tried to summarize this evidence in the Chr onic Care Model (CCM) to guide quality improvement. In this paper we descri be the CCM, its use in intensive quality improvement activities with more t han 100 health care organizations, and insights gained in the process.