Development of a General Practice plus Compact Regional Practice Consortium-based Chronic Disease Management Model with International Chronic Disease Management Models and Experiences as a Reference

Abstract

The community-based chronic disease containment in China is still in its infancy, and there is a lack of a complete system for practical implementation with tertiary and secondary or primary hospitals collaboratively involved. We systematically summarized the development of chronic disease management in China, then analyzed the essentials of three major foreign chronic disease management models (chronic care model, innovative care for chronic conditions framework, and chronic disease self-management program) and chronic disease management experiences of Finland, the U.S., Australia, Japan with a focus on management ideas, systematic structures, and operable approaches. With these foreign models and experiences as a reference, we developed a general practice plus compact regional medical consortium-based chronic disease management model used in Lishui Town with complexity science and analysis for resource integration, against the backdrop of promoting the development of the compact county medical consortium and contracted family doctor services. We expect that our study could provide new ideas for the research on chronic disease containment in China's primary care.

Keywords

• chronic disease|management model|general practice|compact county medical community|complexity science