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: 1.73). 11/2011; 105(1):55-64. DOI: 10.1016/j.healthpol.2011.10.006
Source: PubMed

ABSTRACT 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.

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    • "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]. "
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    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 · 1.66 Impact Factor
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    • "Changes in physical, social, economic, information, and policy environments during the past 30 years have contributed to large increases in childhood obesity rates in the United States (1,2). No single solution will be sufficient to offset these trends — large reductions in childhood obesity rates require action from multiple stakeholders, and public policy action is essential (3–16). "
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    ABSTRACT: No single solution exists to reduce rates of childhood obesity in the United States, but public policy action is essential. A greater understanding of policy maker views on childhood obesity would provide insight into ways that public health advocates can overcome barriers to propose, enact, and implement obesity prevention policies. We conducted 48 in-depth, qualitative interviews with town/city, county, and state policy makers in the state of New York from December 14, 2010, through June 10, 2011. We used a semistructured interview protocol to solicit policy maker views on the causes of, solutions to, and responsibility for addressing the issue of childhood obesity. Most policy makers considered the issue of childhood obesity to be of high importance. Respondents cited changes to family structures as a major cause of childhood obesity, followed by changes in the external environment and among children themselves. Respondents offered varied solutions for childhood obesity, with the most common type of solution being outside of the respondent's sphere of policy influence. Policy makers cited the need for joint responsibility among parents, government, schools, and the food industry to address childhood obesity. Beliefs of many policy makers about childhood obesity are similar to those of the general public. Findings highlight the need for future research to inform the development of communication strategies to promote policy action among those with authority to pass and implement it.
    Preventing chronic disease 11/2013; 10:E195. DOI:10.5888/pcd10.130164 · 1.96 Impact Factor
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    • "Integrated care models promise to provide a solution to control these health care challenges [13,14]. For designing such integrated care models, the Chronic Care Model (CCM) [15] provides a solid and evidence based framework, as acknowledged by the World Health Organization [16]. The CCM was developed to transform the health care system into a system that is equipped for chronic diseases by offering proactive, patient-centered, and integrated care. "
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    ABSTRACT: Background Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care. Methods/Design The CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program – combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period. Discussion This study could provide evidence for the effectiveness of Embrace. Trial registration The Netherlands National Trial Register NTR3039
    BMC Geriatrics 06/2013; 13(1):62. DOI:10.1186/1471-2318-13-62 · 2.00 Impact Factor
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