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Questions and Answers
What is the primary focus of community health management?
What is the primary focus of community health management?
Which component is most crucial in delivering effective community health management?
Which component is most crucial in delivering effective community health management?
In a community health system, which aspect primarily supports local health initiatives?
In a community health system, which aspect primarily supports local health initiatives?
Which is the least associated with effective community health management?
Which is the least associated with effective community health management?
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What role does delivery play in community health management?
What role does delivery play in community health management?
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Which of the following best describes noncommunicable diseases (NCDs)?
Which of the following best describes noncommunicable diseases (NCDs)?
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What is a primary characteristic of noncommunicable diseases?
What is a primary characteristic of noncommunicable diseases?
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Which factor does NOT contribute to the development of noncommunicable diseases?
Which factor does NOT contribute to the development of noncommunicable diseases?
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Which of the following organizations has provided a definition for noncommunicable diseases?
Which of the following organizations has provided a definition for noncommunicable diseases?
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What role do state health departments play in relation to community organizations?
What role do state health departments play in relation to community organizations?
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What type of diseases do NCDs most closely relate to?
What type of diseases do NCDs most closely relate to?
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Which organization is mentioned as a valuable partner for state health departments?
Which organization is mentioned as a valuable partner for state health departments?
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What is a primary focus of the collaboration between state health departments and community organizations?
What is a primary focus of the collaboration between state health departments and community organizations?
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What type of interventions do state health departments aim to enhance through collaboration?
What type of interventions do state health departments aim to enhance through collaboration?
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Why is collaboration between state health departments and national organizations important?
Why is collaboration between state health departments and national organizations important?
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What is essential for decision-makers to enhance their effectiveness?
What is essential for decision-makers to enhance their effectiveness?
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How should effective educating methods be used according to the guidelines?
How should effective educating methods be used according to the guidelines?
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What can hinder decision-makers from making informed choices?
What can hinder decision-makers from making informed choices?
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Why is ongoing training important for providers?
Why is ongoing training important for providers?
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What role do guidelines play in the education of providers?
What role do guidelines play in the education of providers?
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What is one purpose of tracking the performance of the healthcare team?
What is one purpose of tracking the performance of the healthcare team?
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At what level should improvement efforts be tracked according to the information provided?
At what level should improvement efforts be tracked according to the information provided?
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Which group is primarily involved in supporting quality improvement efforts?
Which group is primarily involved in supporting quality improvement efforts?
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What might be a consequence of not tracking healthcare performance?
What might be a consequence of not tracking healthcare performance?
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Why is it essential to identify patients needing more care?
Why is it essential to identify patients needing more care?
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What is one method mentioned for improving patient outcomes?
What is one method mentioned for improving patient outcomes?
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Which of the following is NOT mentioned as a way to improve patient outcomes?
Which of the following is NOT mentioned as a way to improve patient outcomes?
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How can technology contribute to better patient outcomes?
How can technology contribute to better patient outcomes?
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What aspect of healthcare communication is emphasized in relation to patient outcomes?
What aspect of healthcare communication is emphasized in relation to patient outcomes?
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Which combination of factors contributes to improved patient outcomes?
Which combination of factors contributes to improved patient outcomes?
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Study Notes
Chronic Care Model (CCM)
- The CCM is a model developed by Wagner and adapted by organizations like the CDC.
- It's a framework for improving chronic disease management.
- It aims to improve healthcare quality and prevent complications.
- The CCM seeks to ensure high-quality care across various illnesses, settings, and populations.
- It fosters partnerships between providers and communities.
- The CCM's goal is to improve patient health, provider satisfaction, and reduce costs.
Objectives of the Chronic Care Model
- Define the chronic condition.
- Identify the purpose of the chronic care model.
- Identify three risk factors leading to chronic disease.
- Identify the management of chronic conditions.
- Identify the elements of the model.
- Identify the application of CCM into practice.
Definition of Chronic Condition
- A chronic condition refers to any long-term health issue needing continuous self-management by the individual and regular interaction with the healthcare system.
Definition of Non-Communicable Diseases (NCDs)
- Also called chronic diseases, NCDs are typically long-lasting.
- They result from a mix of genetic, physiological, environmental, and behavioral factors (according to the WHO).
Risk Factors for Chronic Diseases
- Poor dietary habits
- Lack of physical activity
- Tobacco use
- Excessive alcohol consumption
- Aging
- Bad lifestyle
Statistics on Chronic Diseases in Jordan (2016)
- Jordan experienced 29,855 deaths in 2016.
- 76% (22,690) of these deaths were attributed to NCDs.
- In 2025, the number of NCD-related deaths is expected to rise to 29,487.
- These deaths are primarily caused by cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.
- The risk of death from an NCD between the ages of 30 and 70 in Jordan is 20%.
- In 2010, 13% of the population had chronic diseases.
- 34% of Jordanian families had at least one member affected by a chronic disease
Chronic Diseases Worldwide Statistics (2022)
- A pie chart displays the percentage distribution of various chronic diseases.
- Information on percentages is provided for diseases like "no chronic diseases," "diabetes," "chronic lung disease," "cardiopathy," "hypertension," "cancer", "hepatic disease", and "stroke".
Definition of the Chronic Care Model (CCM)
- The CCM model is designed to improve the management of chronic diseases.
- It emphasizes patient-centered care, self-management, and integrated health care systems.
Chronic Care Model Purposes
- Enhancing Patient Self-Management: Empowering patients through education and tools to actively manage their health.
- Improving Health Outcomes: Using evidence-based systems to improve clinical results and prevent disease exacerbations.
- Reducing Healthcare Costs: Preventing complications and minimizing hospitalizations.
- Increasing Patient Satisfaction: Providing high-quality, patient-centered care.
- Strengthening Provider Support: Encouraging collaborative care teams.
- Integrating Community Resources: Partnering with community programs to enhance patient support.
Model Elements
- Community
- The health system
- Self-management support
- Delivery system design
- Decision support
- Clinical information systems
Community Resources to Meet Patient Needs
- Motivate patients to engage in impactful community programs.
- Collaborate with community organizations to establish and enhance interventions that address unmet service needs.
- Advocate for policies that prioritize improved patient care.
The Health System
- Ensure visible support for improvement initiatives.
- Promote impactful strategies for achieving comprehensive system-wide changes.
- Encourage transparent and systematic management of errors and quality concerns.
- Introduce incentives that prioritize and reward high-quality care.
- Create agreements to enhance care coordination within and across organizations.
Self-Management Support
- Highlight the patient's key role in managing their health.
- Implement effective self-management strategies.
- Organize both internal and community resources to offer continuous self-management support to patients.
- Patients make decisions with impact.
- Success of disease management is influenced by patients managing their health.
Delivery System Design
- Ensure the provision of effective, efficient clinical care.
- Clearly define roles and distribute responsibilities.
- Utilize planned interactions to facilitate evidence-based care.
- Offer clinical case management.
- Ensure consistent follow-up by the care team.
- Provide understandable care aligned with cultural values.
Decision Support
- Share evidence-based guidelines.
- Use effective methods to educate providers.
- Incorporate specialist expertise.
- Treatment decisions should be based on evidence-backed guidelines.
Clinical Information Systems
- Provide timely reminders for providers and patients.
- Support individualized care planning.
- Enable information sharing.
- Track the performance of the healthcare team and system.
Updated CCM Themes (2003)
- Patient Safety
- Cultural Competency
- Care Coordination
- Community Policies
- Case Management
Application of CCM in Practice
- National patient organizations (e.g., HCAC, JUH) applying CCM.
- National center for Diabetes (DM) example.
Article: Operationalizing the Chronic Care Model with Goal-Oriented Care
- This article discusses operationalizing CCM through goal-oriented care, focusing on chronic disease management.
- It highlights patient-centered care, self-management, and integrated healthcare systems.
- The article outlines how technology and data management help track patient progress.
Article: Results
- The article emphasizes the effectiveness of CCM combined with goal-oriented care.
- Results show improvements in patient outcomes through self-management, improved communication, utilization of technology, and patient engagement.
Conclusion
- Summarizes the key points of the model.
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Description
Test your knowledge on community health management and noncommunicable diseases (NCDs). This quiz covers crucial components, roles of organizations, and essential characteristics related to effective health initiatives at the community level. Dive into the intricacies of health management and explore how various factors contribute to public health.