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Strengthening the Chronic Care Model with goal-oriented care enhances person-centered approaches. This integration focuses on individual life goals to guide collaborative clinical decisions, improving care for chronic conditions.

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Area of Science:

  • Health Services Research
  • Patient-Centered Care
  • Chronic Disease Management

Background:

  • The Chronic Care Model (CCM) has been a cornerstone of healthcare quality improvement for two decades.
  • Existing models emphasize patient-centeredness and disease management but can be further enhanced.

Purpose of the Study:

  • To propose strengthening the Chronic Care Model (CCM) with a goal-oriented care approach.
  • To advance person-centered care by integrating individual life goals into clinical decision-making.

Main Methods:

  • Building upon each element of the Chronic Care Model (CCM).
  • Integrating the principles of goal-oriented care.
  • Providing clinical examples for operationalizing the adapted approach.

Main Results:

  • The proposed approach enhances the CCM by prioritizing what matters most to individuals.
  • Goal-oriented care facilitates collaborative decision-making between patients and clinicians.
  • The adapted model offers a framework for managing growing multi-morbidity.

Conclusions:

  • Integrating goal-oriented care into the CCM offers a robust strategy for person-centered healthcare.
  • This approach is particularly relevant for addressing the complexities of multi-morbidity.
  • Operationalizing goal-oriented care can improve the effectiveness of chronic illness management.