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Home‐Based Chronic Care: An Expanded Integrative Model for Home Health Professionals

Suter, Paula RN, MA; Hennessey, Beth RN, MSN; Harrison, Gregory BMin; Fagan, Martha CPA, MBA; Norman, Barbara RN, BSN; Suter, W. Newton PhD

doi: 10.1097/01.NHH.0000316700.76891.95
Home-Based Chronic Care

The Chronic Care Model (CCM) developed by Wagner (1998) is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a “division of labor” to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.

Paula Suter, RN, MA, is Director of Chronic Care, Baptist Health Home Health and Hospice, Little Rock, AR.

Beth Hennessey, RN, MSN, is Administrator, Baptist Health Home Health and Hospice, Little Rock, AR.

Gregory Harrison, BMin, is Business Development Manager, Baptist Health Home Health and Hospice, Little Rock, AR.

Martha Fagan, CPA, MBA, is Director of Business Operations, Baptist Health Home Health and Hospice, Little Rock, AR.

Barbara Norman, RN, BSN, is Director of Clinical Support, Baptist Health Home Health and Hospice, Little Rock, AR.

W. Newton Suter, PhD, is Professor, University of Arkansas at Little Rock, Little Rock, AR.

Address for correspondence: Paula Suter, RN, MA, Baptist Home Health, 1900 Colonel Glenn Road, Little Rock, AR 72210 (e-mail: paula.suter@baptist-health.org).

© 2008 Lippincott Williams & Wilkins, Inc.