Figure 1

The chronic care model, as described by Wagner et al, [13]identifies six essential elements for appropriate care of people with chronic diseases: 1) community linkages, 2) health care organization, 3) delivery system redesign, 4) clinical information systems, 5) decision support, and 6) self-management support for patients. Taken collectively, these six elements are intended to produce effective interactions between proactive prepared practice teams and informed activated patients who take an active part in their care. (Image from http://www.improvingchroniccare.org).