Il Chronic Care Model

In recent years, the incidence rate of chronic diseases shows a steady increase in every industrialized Country. The almost logarithmic trend of the number of people living with chronic diseases is constantly on the rise. Each predictive statistical model indicates a strong impact for national health systems at the level of the organization of care and management costs. It is urgent to systematically introduce an evidence-based care model in chronic care management such as the Chronic Care Model. The Chronic Care Model is the reference model for WHO. The Chronic Care Model allows for personalized, holistic, multi-professional assistance, characterized by a strong humanization of care, by preventive interventions and relationships between healthcare professionals, patients and caregivers as a system of care and assistance. The fundamental roles are social integration and the improvement of the quality of life of patients. The Chronic Care Model involves the use of a computerized system of information flow and telemedicine and trained healthcare professionals. The Chronic Care Model showed an improvement in the quality of life, a reduction in the number of hospitalizations, a better adherence to therapies, and a reduction in costs.

Evaluation of Effectiveness of Chronic Care Model on Smokeless Tobacco Cessation by Measuring Urinary Cotinine Level among the Patient Attended in the Selected Dental College & Hospital, India -An Experimental Study

Background: Smokeless tobacco is one of the most common causes of preventable death. It is a big social and health issue. Smokeless tobacco utilization is a significant cause of morbidity and mortality in India, with more than 20% of the world's tobacco-related mortality occurring in India. The Chronic Care Model is a guide for the principal care management of higher-quality chronic diseases. The Chronic Care Model gives a structure that redirects health care resources to better meet the demands and issues of individual with chronic illness. Objectives: To explore the effectiveness of chronic care model for smokeless tobacco cessation in patients reporting to Sharad Pawar Dental College and Hospital. Methodology: The study will be conducted among patients reporting to Out Patient Department of Sharad Pawar Dental College and Hospital who are chronic smokeless tobacco users. This study will be conducted between two groups, in one of the groups chronic Care Model will be used and behavioural counselling will be given and in other group only behavioural counselling will be given. Urinary cotinine level test will be performed on both groups of patients consuming smokeless tobacco. Results: The chronic care model would be advantageous for the smokeless tobacco cessation. In India, there appears to be an immediate need for the promotion of awareness and informing people about the health problems associated with the use of smokeless tobacco through the model of chronic care. Conclusion: The utilization of Chronic Care Model (CCM) helps patient realize that not only it is a habit to use smokeless tobacco, but a chronic condition that requires long-term treatment to cure it.

Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records

Background Health systems are undergoing widespread adoption of the collaborative chronic care model (CCM). Care structured around the CCM may reduce costly psychiatric hospitalizations. Little is known, however, about the time course or heterogeneity of treatment effects (HTE) for CCM on psychiatric hospitalization. Rationale Assessment of CCM implementation support on psychiatric hospitalization might be more efficient if the timing were informed by an expected time course. Further, understanding HTE could help determine who should be referred for intervention. Objectives (i) Estimate the trajectory of CCM effect on psychiatric hospitalization rates. (ii) Explore HTE for CCM across demographic and clinical characteristics. Methods Data from a stepped wedge CCM implementation trial were reanalyzed using 5 570 patients in CCM treatment and 46 443 patients receiving usual care. Time-to-event data was constructed from routine medical records. Effect trajectory of CCM on psychiatric hospitalization was simulated from an extended Cox model over one year of implementation support. Covariate risk contributions were estimated from subset stratified Cox models without using simulation. Ratios of hazard ratios (RHR) allowed comparison by trial arm for HTE analysis, also without simulation. No standard Cox proportional hazards models were used for either estimating the time-course or heterogeneity of treatment effect. Results The effect of CCM implementation support increased most rapidly immediately after implementation start and grew more gradually throughout the rest of the study. On the final study day, psychiatric hospitalization rates in the treatment arm were 17% to 49% times lower than controls, with adjustment for all model covariates (HR 0.66; 95% CI 0.51–0.83). Our analysis of HTE favored usual care for those with a history of prior psychiatric hospitalization (RHR 4.92; 95% CI 3.15–7.7) but favored CCM for those with depression (RHR 0.61; 95% CI: 0.41–0.91). Having a single medical diagnosis, compared to having none, favored CCM (RHR 0.52; 95% CI 0.31–0.86). Conclusion Reduction of psychiatric hospitalization is evident immediately after start of CCM implementation support, but assessments may be better timed once the effect size begins to stabilize, which may be as early as six months. HTE findings for CCM can guide future research on utility of CCM in specific populations.