The Chronic Care Model can be thought of as a circle within a circle that together,
through productive interactions between the informed, activated patient and the
prepared, proactive practice team, leads to functional and clinical outcomes.
The outer circle stands for Community, the primary principle, which is comprised
of Resources and Policies. It contains all the other elements within the smaller
circle. The other elements include the Health System, which is the organization
of Health Care; Self-Management Support; Delivery System Design; Decision Support;
and Clinical Information Systems. An arrow delineates that combined, these elements
of Chronic Care are influenced by the Productive Interactions of both the Informed,
Activated Patient and the Prepared, Proactive Practice Team and altogether the
outcome is Functional and Clinical Outcomes.