CCM kort

Question 1

Self-management support

Answer 1

Patients managing their own health

Question 2

How self-management support can be achieved

Answer 2

Emotional support
Knowledge about living with condition
Sustaining healthy behaviours

Question 3

Delivery system design

Answer 3

Delivery of planned, effective and efficient care

Question 4

How delivery design can be achieved

Answer 4

Defining roles and distributing tasks
Provide case-management services
Regular follow-up
Planned interactions to support EBC
Care that fits patients personal background & is understandable

Question 5

Decision support

Answer 5

Clinical care that is consistent with scientific evidence and patient preferences

Question 6

How decision support can be achieved

Answer 6

Evidence-based guidelines in practice
Integrating specialist expertise
Using proven provider methods
Share guidelines and information with patient

Question 7

Clinical information systems

Answer 7

Organization of patient and population data to facilitate efficient and effective care

Question 8

How clinical information systems can be achieved

Answer 8

Timely reminders for providers and patients
Sharing information to coordinate care
Identifying relevant subpopulations for proactive care
Facilitating individual patient care planning
Monitoring performance of practice and care team