Deploying the chronic care model to implement and sustain diabetes self-management training programs

Diabetes Educ. Mar-Apr 2006;32(2):253-60. doi: 10.1177/0145721706287156.


Purpose: The purpose of this project was to evaluate the utility of using the 6 elements of the chronic care model (CCM; health system, community, decision support, self-management support, clinical information systems, and delivery system design) to implement and financially sustain an effective diabetes self-management training (DSMT) program.

Methods: The University of Pittsburgh Medical Center (UPMC) uses all elements of the CCM. Partnerships were formed between UPMC and western Pennsylvanian community hospitals and practices; the American Diabetes Association DSMT recognition program provided decision support. A clinical data repository and reorganization of primary care practices aided in supporting DSMT. The following process and patient outcomes were measured: number of recognized programs, reimbursement, patient hemoglobin A1C levels, and the proportion of patients who received DSMT in primary care practices versus hospital-based programs.

Results: Using elements of the CCM, the researchers were able to gain administrative support; expand the number of recognized programs from 3 to 21; cover costs through increased reimbursement; reduce hemoglobin A1C levels (P < .0001), and increase the proportion of patients receiving DSMT through delivery in primary care (26.4% suburban; 19.8% urban) versus hospital-based practices (8.3%; P < .0001).

Conclusions: The CCM serves as an effective model for implementing and sustaining DSMT programs.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Chronic Disease
  • Delivery of Health Care
  • Diabetes Mellitus / psychology
  • Diabetes Mellitus / rehabilitation*
  • Humans
  • Models, Theoretical
  • Patient Education as Topic / methods*
  • Self Care*
  • Social Support