Integrated care for chronic conditions: The contribution of the ICCC Framework

Basque Institute for Healthcare Innovation, Plaza Asua 1, 48150 Sondika, Vizcaya, Spain.
Health Policy (Impact Factor: 1.91). 11/2011; 105(1):55-64. DOI: 10.1016/j.healthpol.2011.10.006
Source: PubMed


The aim of this research is to highlight the current relevance of the Innovative Care for Chronic Conditions (ICCC) Framework, as a model for change in health systems towards better care for chronic conditions, as well as to assess its impact on health policy development and healthcare redesign to date.
The authors reviewed the literature to identify initiatives designed and implemented following the ICCC Framework. They also reviewed the evidence on the effectiveness, cost-effectiveness and feasibility of the ICCC and the earlier Chronic Care Model (CCM) that inspired it.
The ICCC Framework has inspired a wide range of types of intervention and has been applied in a number of countries with diverse healthcare systems and socioeconomic contexts. The available evidence supports the effectiveness of this framework's components, although no study explicitly assessing its comprehensive implementation at a health system level has been found.
As awareness of the need to reorient health systems towards better care for chronic patients grows, there is great potential for the ICCC Framework to serve as a road map for transformation, with its special emphasis on integration, and on the role of the community and of a positive political environment.

48 Reads
    • "These levels extend the involvement of community and describe policies and financing as the drivers at the macro level (Bengoa et al., 2004). Nuño et al. (2012) suggest the need for further studies which explicitly assess the implementation of the Innovative Care for Chronic Conditions Framework at health system level, but argued that many components of it had been assessed in the literature that is related to the Chronic Care Model previously. A study conducted in the United States of America, recently identified that chronic disease education, specifically support and self management was not well integrated into their undergraduate nursing curricula (Kuebler et al., 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Chronic Care Model developed by Wagner is recognised to provide a systematic approach to managing chronic care. It has been adapted by the World Health Organization to become the Innovative Care for Chronic Conditions Framework. Together these have been demonstrated to provide an effective framework for chronic care management in a variety of settings. In order to prepare Australian nursing graduates for a changing health system it is important to recognise global issues and to prepare them to work within well recognised models. This paper examines the publically available documentation of pre-registration nursing degrees in Australia for their alignment with the Chronic Care Model and the Innovative Care for Chronic Conditions Framework. Those aspects of each which are well addressed are identified along with those which could be improved. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Nurse education today 08/2015; 35(12). DOI:10.1016/j.nedt.2015.08.008 · 1.36 Impact Factor
  • Source
    • "Chronic diseases in the developing countries account for 0.02% to 6.77% of the United States national GDP (WHO, 2011). By 2030 almost 80% of the human deaths globally will be due to chronic diseases (Samb et al., 2010; Nuno et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic diseases are lifelong medical conditions that evolve over the lifespan of a person. Even if they can be treated and controlled, their long-term effects pose great pressure to the global health supply chains. Motivated by the need for active and sustainable interventions in the healthcare sector, we provide a first-effort approach to capture their behavior by focusing on the chronic disease patient flow. The latter delivers the necessary dynamic patterns to health supply chains, when an in-depth analysis is prerequisite to face strategic managerial problems related to issues such as social aspects (patients’ quality of life), health insurance, pharmaceutical industry, etc. To this end, firstly, we identify the major echelons of this health supply chain and we outline the respective physical flows. Secondly, we develop a System Dynamics (SD) model using a numerical example that illustrates the behavior of the system over a period of seven years. Finally, we proceed to suggestions for on-going research highlighting the need to capture the non-linear complex dynamic behavior of the chronic disease patient process. The proposed framework and the SD model provide an overview of the process of the patients that suffer from chronic disease issues. The model could be a tool for shaping public policies and outline appropriate business strategies for the benefit of all the market stakeholders.
    1st International Conference on Agrifood Supply Chain Management & Green Logistics, Porto Carras, Grand Resort, Halkidiki, Greece; 05/2015
  • Source
    • "However, there is no evidence that it has been used in Zambia; few health officials had heard of the model and none had any knowledge of its application in health policy discussions or in MoH strategies. It seems to have been little used elsewhere in Africa [66-68]. Our research results lead us to concur with researchers who have argued that the available and commonly cited models - all of which stem from experimentation and application in the ‘north’ [69]- are of limited use in Africa because they presume the presence of medical technologies, adequate numbers of skilled professional staff, and well-developed health systems [25,28]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The rapid evolution in disease burdens in low- and middle income countries is forcing policy makers to re-orient their health system towards a system which has the capability to simultaneously address infectious and non-communicable diseases. This paper draws on two different but overlapping studies which examined how actors in the Zambian health system are re-directing their policies, strategies and service structures to include the provision of health care for people with chronic conditions. Methods Study methods in both studies included semi-structured interviews with government health officials at national level, and governmental and non-governmental health practitioners operating from community-, primary health care to hospital facility level. Focus group discussions were conducted with staff, stakeholders and caregivers of programmes providing care and support at community- and household levels. Study settings included urban and rural sites. Results A series of adaptations transformed the HIV programme from an emergency response into the first large chronic care programme in the country. There are clear indications that the Zambian government is intending to expand this reach to patients with non-communicable diseases. Challenges to do this effectively include a lack of proper NCD prevalence data for planning, a concentration of technology and skills to detect and treat NCDs at secondary and tertiary levels in the health system and limited interest by donor agencies to support this transition. Conclusion The reorientation of Zambia’s health system is in full swing and uses the foundation of a decentralised health system and presence of local models for HIV chronic care which actively involve community partners, patients and their families. There are early warning signs which could cause this transition to stall, one of which is the financial capability to resource this process.
    BMC Health Services Research 07/2014; 14(1):295. DOI:10.1186/1472-6963-14-295 · 1.71 Impact Factor
Show more