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The ten characteristics of the high-performing chronic care system

Published online by Cambridge University Press:  01 January 2010

Chris Ham*
Professor of Health Policy and Management, Health Services Management Centre, University of Birmingham, Birmingham, UK
Correspondence to: Chris Ham, Professor of Health Policy and Management, Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Road, Birmingham B15 2RT, UK. Email:


The purpose of this paper is to describe the characteristics of the high-performing chronic care system and the four implementation strategies needed to achieve such a system. The paper starts with a description of the Chronic Care Model and summarises evidence on its impact. This is followed by a review of international evidence on gaps in the quality of chronic care. These gaps suggest that, useful and influential as the Chronic Care Model is, more is needed to help health care decision makers bring about the reorientation required to meet the needs of populations in which chronic diseases predominate. The second half of the paper therefore sets out the ten characteristics and four implementation strategies required to achieve a high-performing chronic care system. In doing so, it provides practical guidance to policy makers and health care leaders on the most promising strategies for improving the provision of chronic care, drawing on evidence from the experience of England, New Zealand and USA.

Copyright © Cambridge University Press 2009

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