ABSTRACT:The growing number of persons suffering from major chronic illnesses face many obstacles in coping with their condition, not least of which is medical care that often does not meet their needs for effective clinical management, psychological support, and information. The primary reason for this may be the mismatch between their needs and care delivery systems largely designed for acute illness. Evidence of effective system changes that improve chronic care is mounting. We have tried to summarize this evidence in the Chronic Care Model (CCM) to guide quality improvement. In this paper we describe the CCM, its use in intensive quality improvement activities with more than 100 health care organizations, and insights gained in the process.T he number of persons with chronic illness is growing at an astonishing rate because of the rapid aging of the population and the greater longevity of persons with many chronic conditions. Fortunately, the effectiveness of care of major chronic illnesses such as hypertension, congestive heart failure, depression, and diabetes has been enhanced by much recent progress in clinical and behavioral interventions. But many persons receiving care for these conditions are not reaping the benefits of these advances. For example, recent surveys suggest that fewer than half of U.S. patients with hypertension, depression, diabetes, and asthma are receiving appropriate treatment.Why is care for chronic conditions so deficient? A recent Institute of Medicine (IOM) report attributes the quality gap to (1) the in-

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