.

2
Asessment of Chronic
Illness Care (ACIC)
172

odd ratio



69.7
( 80.9)

( 50.0) 52.3
( 80.9)
ACIC
(Self Management Support)
(
)

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ACIC MacColl
Chronic Care Mode

(Insight)

(Introduction)

(1)
4

1)

2)



3)

4)

(2)

(medical consultant)



(3)

(4)

(9)

(diseases of long duration and generally slow progression)
2545
MacColl Institute for Healthcare Innovation(4)



Chronic Care Model
1

1 The Chronic Care Model


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(Chronic illness)

(Any
condition that requires ongoing activities and response
from patients and their personal caregivers, as well as
Medicare system)
6
(Self-management
support) (Delivery System Design)
(Decision support)
(Clinical information system)

(Cerebrovascular disease)
(.)

(5)

(Model)

1 (6)

()

12
22
6
6
12
5
6
15
84

()
142
269
71
118
123
94
71
210
1,098

1.



2.

3

1

(Asessment of Chronic

Illness Care: ACIC) MacColl Institute USA

(Materials and Methods)

The Thai Journal of Primary Care and Family Medicine 

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 WHO translation standards guideline

content validity reliability

2
8

stratified sampling ( p =
0.05 95% CI +/- 10) 3
8


84 1,098
Precision
88 170
response rate 70%
220

3

2

1



-

-

-

-

-




-

-

-



2
(Asessment of Chronic Illness Care: ACIC)
Basic element MacColl Institutes
Chronic care model
(Self-management support)

(Delivery System Design)

(Decision support)
(Clinical information system)
ACIC

1.

2.

3.

4.

5.

6.

7.




ACIC
11
0 11

0



11

0 2 =

3 5 =





6 8 =





9 11 =

(Result)

172 120 69.7%

(ACIC)

1.


( 80.9)
ACIC
( 60.6) 19.1
2.1
( 2)

10
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 2 ACIC

(Health care personal)

(Physician)
(Nurse)
(Health care officer)
(Pharmacist)
(Physical therapist)
(social worker)
(Other eg. Health volunteer)

19.1
80.9
60.6
31.9
29.8
2.1
39.4

ACIC > 6
OR
P value
0.37
0.848
8.91
0.012*
0.19
0.904
1.91
0.168
3.35
0.067
0.02
0.886
0.661
0.416

2.

ACIC 50
44 32

ACIC
( 3)

3 ACIC

17.0

ACIC > 6
OR
P value
0.46
0.500

13.8

1.14

0.621

50.0

0.49

0.351

17.0

0.41

0.911

21.3

1.21

0.275

26.6

1.14

0.991

24.5

0.66

0.578

35.1

1.14

0.774

44.7

0.10

0.744

31.9

0.17

0.781

3.

53 (Activities of Daily Living, ADL)
ADL
ACIC

11

( 4)
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4 ACIC
(Index)
Quality of Life index
Activity daily living
Instrumental activity daily living
Satisfaction score
Other eg. clinical outcome, readmission

30.9
53.2
11.2
45.7
11.7

ACIC > 6
OR
P value
2.89
0.089
3.77
0.05*
0.18
0.893
0.57
0.476
1.13
0.295

4.

80 64
60
8.5 ACIC

( 5)

5 ACIC
(Index)

Take blood exam

Intravenous fluid therapy
Physical rehabilitation
Wound care
Care for Nasogastric tube / Urinary tract tube
Intravenous injection
Bronchodilator
Other eg. Intramuscular injection
Took oral medication for patient at home

30.9
8.5
63.8
80.9
58.5
12.8
25.5
20.2
47.9

ACIC > 6
OR
P value
1.02
0.321
0.50
0.474
0.45
0.504
0.32
0.574
2.31
0.157
0.18
0.666
0.81
0.376
2.60
0.102
0.14
0.721

5. ACIC

5.1

(CMU) ACIC

CMU


5.2

(CMU) ACIC

5.3

(CMU) ACIC

CMU

12
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5.4

(CMU) ACIC



5.5

(CMU) ACIC



5.6

(CMU) ACIC

CMU



5.7

(CMU)
CMU
( 6)

6 95% CI

Health system Organization
()
Community linkage and polices
( )

95%CI 95%CI 95%CI 95%CI

6.33 5.74-6.92 9.00 -3.71-21.71 7.34 6.08-8.60 6.20 5.39-7.02
6.37 5.77-6.97 8.66 0.22-17.11

7.53 6.44-8.61 6.49

5.71-7.27

Self management support

(

5.47 4.92-6.02 8.25 -4.46-20.96 6.28 5.33-7.24 4.99 4.36-5.61

Decision support
()

6.24 5.69-6.78 9.83 9.82-9.85 6.72 5.57-7.86 5.38 4.67-6.09

Delivery system design

()
Clinical information system
()
Component integration
()

6.24 5.69-6.78 9.83 9.81-9.89

6.71 5.57-7.86 5.37 4.67-6.09

5.37 5.65-5.95 8.60 -14.27-31.47 7.25 6.16-8.34 5.34

6.11

4.56-6.11

5.54-6.67 8.50 -1.05-2.76 6.98 5.83-8.13 5.28 4.57-5.99

(Self Management
Support)
( )

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(Discussions)

(Self Management Support)
(accessibility)

(10) 10,000
700 91%

96% 32%
30% 4.07 5.15 2544 2546


75%

78



MacCols Chronic Care Model
(Innovation) (Quality assurance)
(10)

14
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(Linear model) Biomedical
Package

Chronic Care Model



(Feedback loop)

(Conclusions)

ACIC
MacColl Chronic Care Mode

(Insight)

MacColl Institute for
Healthcare Innovation ACIC


..



Dona Cutsogeorge MA. www.impro
vechronicillnesscare.org

(.)

1. . . . :
; 2548.
2. CFPC, National Telephone Survey, August 1999
3. Guidelines for the Medical Management of the Home Care Patient. American Home Care Advisory Panel, Arch Fam Med. 1993;
2: 6-8 ,194-206
4. Ruth Elkan, Denise Kendrick, Michael Dewey ,et al. Effectiveness of home based support for older people:systematic review and
meta-analysis BMJ 2001; 323(29)
5. ICIC, MacColl Institute for Healthcare Innovation .Chronic Care Model . Innovation http://www.improvingchroniccare.org/
index.php?p=The_Chronic_Care_Model&s=2
6. .
7. . 1.
: http://203.157.6.200/allclinic/search.html
8. http://gotoknow.org/blog/hhc/54797

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