American Academy of Family Physicians
About UsNews & PublicationsMembersCME CenterClinical & ResearchPractice MgmtPolicy & AdvocacyCareers

Chronic Care Model

The Chronic Care Model, developed by MacColl Institute for Healthcare Innovation advocates for more productive interactions between the patient and his/her care team and describes how the model elements (clinical information systems, decision support, self-management support, delivery system design, the community and organizational leadership) work together to create a patient-centered, proactive health care team. Visit the Web sites below for resources and information about the CCM.

Improving Chronic Illness Care: Overview of the Chronic Care Model -- Explore the elements of the Chronic Care Model.
CCM Presentation -- This online presentation walks you through the Chronic Care Model step-by-step with narration by model developer, Dr. Ed Wagner, national program director, Improving Chronic Illness Care.
Assessment of Chronic Illness Care -- This practice assessment tool will help you gauge how your practice is performing on the six dimensions of the Chronic Care Model.
Shop Catalog