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The Chronic Care Model is a disease management tool that uses a systematic methodology to reorganize medical care and create a partnership between the communities and health systems. The model primarily identifies the critical elements of the healthcare system that inspire high-quality care for chronic disease. The items include the health system, community, self-management support, decision support, delivery system design, and clinical information system. The paper seeks to explain how the chronic care model can be used in diabetic patients with high hemoglobin A1c levels.

The goal is to lower the levels of hemoglobin A1c by using the CCM to identify the interventions that will improve an outcome. The interventions can be classified into decision support, delivery system design, self-management, and community resources.

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Delivery System Designs. Different ways exist that can be utilized to better the care delivery that can improve the hemoglobin levels. Group visits, planned visits of the patients to the medical specialists for assessment and lab work are all efficient in the improvement of clinical outcomes

Decision Support. The literature on decision support shows that reminders are critical in assisting providers to remember to order the tests promptly, however, they have not been proved to improve clinical outcomes. The use of insulin in patients with type 2 diabetes effectively improves the levels of hemoglobin A1c. One must learn how to titrate basal insulin for the patients (Stellefson, Dipnarine, & Stopka, 2013).

Self-Management Support (SMS). Effective self-management supports the interventions in making the clinical hemoglobin A1c outcome better. SMS program should be established.

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Community Resources. The community resource requires that community partners must offer help. They include local diabetic clinics and Diabetes Associations. Internet search has given exceptional sources for patients' resources. The SMS program also will require financing (Duangbubpha et al., 2013).

The APNs will play a critical role in managing patients with chronic diseases and keep track of them. They will provide information on self-care management and training as the model expands, especially with the passage of health reform that has enabled additional 30 million American citizens to acquire health insurances (Wood, 2016).

Thus, improving the clinical outcome for patients with chronic diseases needs a multifaceted method. Care for Chronic Model has a design with an organized framework that enhances chronic illness care.

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