الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
healthcare system. Currently, PHC settings do not seem to be adequately addressing the challenges related to non-clinical aspects of chronic care model. New organizational forms and those adopting a more systemic and integrated approach to maintain a strong individual bond between patients and providers could potentially promote improvements in chronic care model for improvement of the quality of health care provided to the community in the PHC settings.
There is a recipe for improving quality that involves evidence-based guidelines, system change strategies and quality improvement methods. The chronic Care Model (CCM) is an organizational approach to caring for people with chronic disease in a primary care setting. The system is population-based and creates practical, supportive, evidence-based interactions between an informed, activated patient and a prepared, proactive practice team.
The CCM identifies essential elements of a health care system that encourage high-quality chronic disease care: the community; the health system; self-management support; delivery system design; decision support, and clinical information systems. Within each of these elements, there are specific concepts (“Change Concepts”) that teams use to direct their improvement efforts. Change concepts are the principles by which care redesign processes are guided.
chronic illness management will continue to be an important component of health care, identification of the elements of the chronic care model processes an important help to guide future research and clinical practice that support chronic illness management efforts.