Chronic Disease Management Chronic care model Chronic illness Concept of Chronic care

1. แนวคิดการจัดการโรคเรื/อรัง
Chronic Disease management Concept
Krid Thongbunjob , MD , MPH , FRCFPT

2. Outline
1. ธรรมชาติของโรคเรื/อรัง
• ภาวะ Acute & Chronic
• การเกิดภาวะแทรกซ้อน Complication
• การเกิดโรคร่วม Co-mobidity Disease
2. การจัดการโรคเรื/อรัง
• แนวคิดการจัดการโรคเรื8อรัง
• รูปแบบการจัดการโรคเรื8อรัง
q Chronic Care Model
q Trajectory Model
q Integrated Care Model
3. หลักการจัดการโรคเรื/อรัง
§ การจัดการดูแล
• Continuity
• Coordination
• Comprehensive
§ การส่งเสริมการจัดการควบคุมโรค
• การสร้างความสมดุล
• การเสริมสร้างพลังอํานาจ
§ การสนับสนุนการจัดการตนเอง

7. A history of
chronic diseases
• Bynum, B.. (2015). A history of chronic
diseases. The Lancet, 385(9963), 105–106.
https://doi.org/10.1016/s0140-6736(15)60007-1

9. โรคปัจจุบัน : โรคเรื.อรัง
“คุณหมอครับ เป็นโรคเบาหวานมีทางรักษาให้
หายขาดไหมครับ?”
“คุณหมอครับ เป็นโรครูมาติสซัEม ทําไมกินยาเป็นปีๆ
แล้วยังไม่เห็นหายสักที?”
“คุณหมอครับ เป็นโรคหืด หาหมอตัLง MN-PN รายแล้ว
ทําไมไม่เห็นหายสักราย?”
https://www.doctor.or.th/article/detail/5275

10. Natural History and
Spectrum of Disease
• Timeline shows state of susceptibility, exposure, subclinical
disease in which pathologic changes takes place, onset of
symptoms, followed by usual time of diagnosis, clinical disease,
followed by recovery, disability, or death.
Source: Centers for Disease Control and Prevention. Principles of epidemiology, 2nd ed. Atlanta: U.S. Department of Health and Human Services;1992.
https://www.cdc.gov/CSELS/DSEPD/SS1978/Lesson1/Section9.html#TXT118

11. Natural History of Diseases
Jewell NP. Natural history of diseases: Statistical designs and issues. Clin Pharmacol Ther. 2016 Oct;100(4):353-61.
doi: 10.1002/cpt.423. Epub 2016 Aug 18. PMID: 27393601; PMCID: PMC5017909.

12. Clark NM, Gong M. Management of chronic disease by practitioners and patients: are we teaching the wrong things? BMJ. 2000 Feb 26;320(7234):572-5.
doi: 10.1136/bmj.320.7234.572. PMID: 10688569; PMCID: PMC1117606.

14. khwanchum, R. ., Khomkham, P. ., Srisodsaluk, P. ., & Chanseang, S. . (2021). Family and chronic disease management. UBRU Journal for Public Health Research, 10(2), 6–14.
Retrieved from https://he02.tci-thaijo.org/index.php/ubruphjou/article/view/249020

15. Comprehensive Chronic Care
• The most common chronic conditions
• High blood pressure (hypertension)
• Type 2 diabetes
• Heart disease
• Congestive heart failure
• Arthritis
• Asthma
• Chronic obstructive pulmonary disease
(COPD)
• Kidney disease
• Lipid disorders
• Thyroid disorders
• The goals of chronic disease management
are to minimize symptoms, improve
quality of life, and prevent unnecessary
hospitalizations.
https://www.jtatelmanmd.com/services/chronic-disease-management/

16. Get the Facts on Chronic Disease Self-Management
• Every day, millions of people
with chronic conditions
struggle to manage their
symptoms.
• Chronic Disease Self-
Management Program (CDSMP)
is a low-cost program that helps
adults with chronic diseases
learn how to manage and
improve their health.

17. https://www.hse.ie/eng/about/who/gmscontracts/2019agreement/chronic-disease-management-programme/

19. CHAN, Sally Wai-Chi. Chronic Disease Management, Self-Efficacy and Quality of Life. Journal of Nursing Research 29(1):p e129,
February 2021. | DOI: 10.1097/JNR.0000000000000422

20. Chronic disease management programs
• Expected Benefits
• Our evidence rating is based on the likelihood of achieving these
outcomes:
• Improved quality of life
• Improved health outcomes
• Improved mental health
• Reduced hospital utilization

21. Role of
Patient Care Teams
Wagner, E. H.. (2000). The role of patient care teams in chronic disease management. BMJ, 320(7234), 569–572.
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50. Assessing the Growing Role & the
Demand of Apps in Managing the
Chronic Diseases • https://www.delveinsight.com/blog/chronic-disease-
management-apps

51. Artificial intelligence supported patient self-care in chronic heart failure: a
paradigm shift from reactive to predictive, preventive and personalized care
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52. https://www.linkedin.com/pulse/how-ai-can-improve-chronic-disease-management-nitin-gupta

58. https://www.health.wa.gov.au/Articles/A_E/About-Chronic-Condition-Self-Management

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76. https://divisionsbc.ca/richmond/for-patients/pcn

79. https://www.healthcareittoday.com/2016/05/02/3-ehr-gaps-
that-hinder-systematic-chronic-disease-management/

88. https://uw.pressbooks.pub/fc
mtextbook/chapter/chronic-
disease-management-visits/

92. Lesson
learn
form AY
2023

93. Chronic illness – Family
of Violence

94. Family of END of Life

95. Family of Elderly

104. Integrated Care Model

106. Danhieux, K., Martens, M., Colman, E., Wouters, E., Remmen, R., Van Olmen, J., & Anthierens, S.. (2021).
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109. Programme logic model for a chronic kidney disease/diabetes self-management programme
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110. Timpel, P., Lang, C., Wens, J., Contel, J. C., Schwarz, P. E. H., & Care Study Group, O. B. O. T. M.. (2020). The Manage Care Model
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115. Hatano, Y., Matsumoto, M., Okita, M., Inoue, K., Takeuchi, K., Tsutsui, T., Nishimura, S., & Hayashi, T.. (2017).
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120. Sumner, J., & Lim, Y. W.. (2021). Back to the Hospital for Chronic Care: a Hybrid Generalist Model. Journal of General Internal Medicine, 36(3),
782–785. https://doi.org/10.1007/s11606-020-06271-6

123. Harrison, S. R., & Jordan, A. M.. (2022). Chronic disease care integration into primary care services in sub-Saharan Africa: a ‘best fit’ framework synthesis and new
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124. Meiqari, L., Al-Oudat, T., Essink, D., Scheele, F., & Wright, P.. (2019). How have researchers defined and used the concept of ‘continuity of care’ for chronic
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125. Gee, P. M., Greenwood, D. A., Paterniti, D. A., Ward, D.,
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127. Capelli, O., Quattrini, B., Abate, F., Casalgrandi, B., & Cacciapuoti, I.. (2016). Integrated Care for Chronic Diseases – State of the Art.
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128. Bloem, B. R., Henderson, E. J., Dorsey, E. R., Okun, M. S., Okubadejo, N., Chan,
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133. Liu C and Tang S. Integrated care for chronic diseases in Asia Pacific countries. New Delhi: World Health Organization Regional
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135. Cronin, J., Murphy, A., & Savage, E.. (2017). Can chronic
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136. หลักการจัดการโรคเรื.อรัง
• Continuity
• Coordination
• Comprehensive

137. World Health Organization. (2018). Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on
integrated people-centred health services. World Health Organization. https://apps.who.int/iris/handle/10665/274628.

138. Chen, C.-C., Chiang, Y.-C., Lin, Y.-C., & Cheng, S.-H.. (2023). Continuity of Care and Coordination of Care: Can they Be
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140. Verónica Espinel-Flores and others, for Equity LA II, Assessing the impact of
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142. Hu, J., Wang, Y., & Li, X.. (2020). Continuity of Care in Chronic Diseases: A Concept Analysis by Literature
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143. Figure 2. Concept diagram of “continuity of care”.
J Korean Acad Nurs. 2020 Aug;50(4):513-522.
https://doi.org/10.4040/jkan.20079

145. Ljungholm, L., Klinga, C., Edin-Liljegren, A., & Ekstedt, M.. (2022). What matters in care
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146. Santos, M. T. D., Halberstadt, B. M. K., Trindade, C.
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https://doi.org/10.1590/1980-220x-reeusp-2022-
0100en

148. Conceptual Model
of the Relationship
between Care
Continuity and Care
Coordination
Chen LM, Ayanian JZ. Care Continuity and Care Coordination: What Counts? JAMA Intern Med. 2014;174(5):749–750. doi:10.1001/jamainternmed.2013.14331

151. Odds of Incidence of Hospitalizations, ED Visits, and Complications (A) and Percentage
Change in Costs (B) Associated With a 0.1-Unit Increase in the Bice-Boxerman COC Index

154. Pollack, C. E., Hussey, P. S., Rudin, R. S., Fox, D. S., Lai, J., & Schneider, E. C.. (2016).
Measuring Care Continuity. Medical Care, 54(5), e30–e34.
https://doi.org/10.1097/mlr.0000000000000018

164. Haggerty, J. L., Roberge, D., Freeman, G. K., Beaulieu, C., & Breton, M.. (2012). Validation
of a Generic Measure of Continuity of Care: When Patients Encounter Several
Clinicians. The Annals of Family Medicine, 10(5), 443–451.
https://doi.org/10.1370/afm.1378

167. Distribution of usual provider of care indices (n=757 873) based on data from individual patients
(left figure: (UPCpatient)) and at general practitioner (GP) practice level (right figure: UPCGP
list).
Øystein Hetlevik et al. BMJ Open 2021;11:e051958
©2021 by British Medical Journal Publishing Group

172. Freund, T., Campbell, S. M., Geissler, S., Kunz, C. U., Mahler, C.,
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177. Schulte, T., Wurz, T., Groene, O., & Bohnet-Joschko, S.. (2023). Big Data
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182. Ha, N. T., Harris, M., Preen, D., Robinson, S., & Moorin, R.. (2019). A time-duration measure of continuity of care
to optimise utilisation of primary health care: a threshold effects approach among people with diabetes. BMC
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185. Hull, S. A., Williams, C., Schofield, P., Boomla, K., & Ashworth, M.. (2022). Measuring continuity of care in general practice: a comparison of two
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187. Davis KM, Eckert M, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey G. Continuity of care for people with multimorbidity: the
development of a model for a nurse-led care coordination service. Aust J Adv Nurs [Internet]. 2020 Oct. 8 [cited 2023 May 20];37(4).
Available from: https://www.ajan.com.au/index.php/AJAN/article/view/123

189. • How long will I have to wait on the phone to schedule an appointment?
• Does the provider take my insurance?
• How long will I wait to see a specialist — days, weeks or months?
• If I’m in pain or feeling ill, can I see the provider today?
• How far is the provider from my home or workplace?
• How will I get to the appointment?
• Will I have to miss work?
• Can I schedule an appointment time that works for my caregiver and/or loved
one?
• Will the provider speak my language?

190. Care coordination
Convenience Is Key
• Improving Patient Satisfaction in Healthcare
• Avoid unnecessary emergency department visits.
• Establish a primary care relationship
• Prevent no-shows
• Streamline referrals.
• Guide patients through chronic disease management

191. How Care Continuity Strengthens
Patient Satisfaction
• Scheduling follow-up appointments
• Finding network-aligned physicians and/or specialists
• Coordinating with Home Health, SNF, LTAC, etc.
• Arranging transportation
• Scheduling ancillary services
• Assisting with referral coordination
• Providing clinical documentation to stakeholders
• Status check-ins
• Medication adherence

192. What is Care Coordination?
• Perspectives on Care Coordination
• Patient/Family Perspective
• Health Care Professional(s) Perspective.
• System Representative(s) Perspective.
• Additional Terms
• Health care entities
• Points of transition.
• Transitions between entities of health care system
§ Among members of one care team (receptionist, nurse, physician)
§ Between patient care teams
§ Between patients/informal caregivers and professional caregivers
§ Across settings (primary care, specialty care, inpatient, emergency
department)
§ Between health care organizations
• Transitions over time.
§ Between episodes of care (i.e., initial visit and follow-up visit)
§ Across lifespan (e.g., pediatric developmental stages, women's changing
reproductive cycle, geriatric care needs)
§ Across trajectory of illness and changing levels of coordination need

193. Care Coordination Ring

194. Example Scenarios
• Scenario 1. Mrs. Jones is a healthy 55-year-old woman. She
visits her primary care provider, Dr. I. Care, once a year for a
routine physical. Dr. Care practices in a primary care clinic
with an electronic medical record (EMR) system and on-site
laboratory and radiology services. At Mrs. Jones' annual
physical, Dr. Care ordered several blood tests to evaluate
her cholesterol and triglyceride levels. Mrs. Jones also
mentioned that she is having lingering pain in her ankle
after a previous sprain. Dr. Care ordered an x-ray. After
receiving the blood test results via the electronic medical
record system, Dr. Care sees that Mrs. Jones' cholesterol is
high and prescribes a medication. She submits the
prescription directly to the pharmacy via a link from the
EMR. She receives electronic notification that the x-ray does
not show any fracture. She calls Mrs. Jones to refer her to a
nearby physical therapy practice. Mrs. Jones picks up her
medication from the pharmacy and calls the physical
therapist to schedule an appointment.
• Scenario 1. Visual
Complexity: Low
Fragmentation: Low
Patient Capacity: High
Care Coordination Need: Minimal

195. • Scenario 2. Mr. Andrews is a 70-year-old man with congestive heart failure and diabetes. He uses a cane when
walking and recently has had some mild memory problems. His primary care physician, Dr. Busy, is part of a
small group physician practice focused on primary care. The primary care clinic includes a laboratory, but they
refer their radiology tests to a nearby radiology center. Mr. Andrews also sees Dr. Kidney, a nephrologist, and Dr.
Love, a cardiologist. Both specialists are part of a specialty group practice that is not affiliated with Dr. Busy's
clinic. Their specialty practice includes an on-site laboratory, radiology clinic, and pharmacy. Mr. Andrews has
prescriptions filled at the specialty clinic pharmacy after his appointments with Drs. Kidney and Love and picks
up medications prescribed by Dr. Busy at a pharmacy near his home. Mr. Andrews has a daughter who lives
nearby but works full time. Because he has trouble getting to the grocery store to do his shopping, he receives
meals at his home 5 days a week through a meals-on-wheels senior support service. His daughter has hired a
caregiver to help Mr. Andrews with household tasks for two hours three days a week.
• During a recent meal delivery, the program staffer noticed that Mr. Andrews seemed very ill. He called an
ambulance, and Mr. Andrews was taken to the emergency department. There he was diagnosed with a
congestive heart failure exacerbation and was admitted. During his initial evaluation, the admitting physician
asked Mr. Andrews about which medications he was taking, but the patient could not recall what they were or
the doses. The physician on the hospital team contacted Dr. Busy, who provided a medical history and general
list of medications. Dr. Busy noted that Mr. Andrews may have had dosing changes after a recent appointment
with Dr. Love. In addition, Dr. Busy noted that Mr. Andrews may be missing medication doses because of his
forgetfulness. He provided the hospital team with contact information for Drs. Love and Kidney. He also asked
that a record of Mr. Andrews' hospital stay be sent to his office upon his discharge.
• Mr. Andrews was discharged from the hospital one week later. Before going home, the nurse reviewed
important information with him and his daughter, who was taking him home. They went over several new
prescriptions and details of a low-salt diet. She told him to schedule a followup appointment with his primary
care physician within 2 days and to see his cardiologist in the next 2 weeks. Mr. Andrews was very tired so his
daughter picked up the prescriptions from a pharmacy near the hospital, rather than the one Mr. Andrews
usually uses.
• Scenario 2. Visual
Complexity: High
Fragmentation: Moderate
Patient Capacity: Low
Care Coordination Need: Extensive
•

202. Bynum, J. P. W., & Ross, J. S.. (2013). A Measure of Care
Coordination?. Journal of General Internal
Medicine, 28(3), 336–338.
https://doi.org/10.1007/s11606-012-2269-0

203. World Health Organization. (2018). Continuity and
coordination of care: a practice brief to support
implementation of the WHO Framework on integrated
people-centred health services. World Health
Organization. https://apps.who.int/iris/handle/10665/27462
8.

205. Medves, J., Pare, G., Woodhouse, K., Smith-Romeril, C., Li, W., & Tranmer, J.. (2022). The case
for continuity of care for people with chronic obstructive pulmonary disease. International
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207. Schwarz, D., Hirschhorn, L. R., Kim, J.-H., Ratcliffe, H. L., & Bitton, A.. (2019). Continuity in primary care: a critical but
neglected component for achieving high-quality universal health coverage. BMJ Global Health, 4(3), e001435.
https://doi.org/10.1136/bmjgh-2019-001435

208. • The Triple Aim Journey: Improving
Population Health and Patients' Experience
of Care, While Reducing Costs

212. 1.ComprehensivenessComprehensiveness refers to the
provision of holistic and appropriate care across a broad
spectrum of health problems, age ranges, and treatment
modalities. Comprehensive care should address a wide range
of preventive, promotive, chronic, behavioural, and
rehabilitative services and include an assessment of a
patient’s risks, needs, and preferences at the primary care
level. refers to the provision of holistic and appropriate care
across a broad spectrum of health needs, ages, and solutions.
Comprehensive primary health care is able to address a
majority of promotive, preventive, curative, rehabilitative,
chronic and palliative service needs.
https://www.improvingphc.org/improvement-
strategies/quality/primary-care-functions

213. 1.Continuity“Continuity is the degree to which a series of
discrete healthcare events are experienced as coherent and
connected and consistent with the patient’s medical needs
and personal context.” Three types of continuity are
considered to be important for primary care: relational
continuity, informational continuity, and management
continuity. is the degree to which a patient experiences a
series of discrete healthcare events as coherent and consistent
with their medical needs and personal context. This requires
fostering trusted relationships between health care providers
and patients over time (relational continuity), ensuring
information is communicated from one event to the next
(informational continuity), and ensuring the process is
managed in a timely, complementary, and effective way across
providers (management continuity).

214. 1.CoordinationCoordinated. of care refers to the system's
ability to oversee and manage patient care throughout the
course of treatment and across various sites of care to ensure
appropriate follow-up, minimize the risk of error, and prevent
complications. Coordinationnof care happens across levels of
care and over time, and often requires proactive outreach on
the part of health care teams and consistent tracking and
communication of progress.

216. Sumner, J., & Lim, Y. W.. (2021). Back to the Hospital for Chronic Care: a Hybrid Generalist Model. Journal of General Internal Medicine, 36(3), 782–78
https://doi.org/10.1007/s11606-020-06271-6

220. Jonas. (2020). A new model of care to return holism to family medicine. 69(10).
https://doi.org/10.12788/jfp.0110

223. Ko, F. W. S., Chan, K. P., & Hui, D. S. C.. (2019). Comprehensive care for chronic obstructive pulmonary disease. Journal of Thoracic Disease, 11(S17), S2181–S2191.
https://doi.org/10.21037/jtd.2019.09.81

225. Strategic map of the chronicity care plan of the Balearic Islands.
Modified by Miguélez-Chamorro et al

229. Integrated framework for living well with chronic illness. SOURCE: Committee on Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life
National Academies of Sciences, Engineering, and Medicine. 2012. Living Well with Chronic Illness: A Call for Public Health Action. Washington, DC: The National Academies Press.
https://doi.org/10.17226/13272.

232. Niño De Guzmán Quispe, E., Martínez García, L., Orrego Villagrán, C., Heijmans, M., Sunol, R., Fraile-Navarro,
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233. Harricharan, S., McKinnon, M. C., & Lanius, R. A. (2021). How Processing
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234. Harricharan, S., McKinnon, M. C., & Lanius, R. A. (2021). How Processing of Sensory
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236. Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, et al. (2020) Health anxiety and illness-related
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239. A conceptual model of the process and outcome of empowerment as described by patients with long-term conditions in primary care.
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empowerment in long-term conditions: development and preliminary testing of a new
measure. BMC Health Services Research, 13(1), 263. https://doi.org/10.1186/1472-6963-13-263

240. Pritchard, D. E., Moeckel, F., Villa, M. S., Housman, L. T., Mccarty, C. A., & Mcleod, H. L.. (2017).
Strategies for integrating personalized medicine into healthcare practice. Personalized
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246. Power to the Patient

250. Share discision making

251. https://www.youtube.com/watch?v=Lb82_OJjS3g

253. What is Patient Empowerment?
• Patient empowerment is a
process that helps people
gain control over their
own lives and increases
their capacity to act on
issues that they
themselves define as
important.”
• Aspects of empowerment
include:
• self-efficacy
• self-awareness
• confidence
• coping skills
• health literacy

254. The five “E” of Empowerment
• Education: patients can make informed decisions about
their health if they are able to access all the relevant
information, in an easily understandable format.
• Expertise: patientsself-manage their condition every day
so they have a unique expertise on healthcare which
needs to be supported.
• Equality: patients need support to become equal
partners with health professionals in the management
of their condition.
• Experience: individual patients work with patient
organisations to represent them, and channel their
experience and collective voice.
• Engagement: patients need to be involved in designing
more effective healthcare for all, and in research to
deliver new and better treatments and services

255. Connection to Health Patient Flow
Hessler, D. M., Fisher, L., Bowyer, V., Dickinson, L. M., Jortberg, B. T., Kwan, B., Fernald, D. H., Simpson, M., & Dickinson, W. P.. (2019). Self-management support
for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal
selection. BMC Family Practice, 20(1). https://doi.org/10.1186/s12875-019-1012-x

260. O’Connell, S., Mc Carthy, V. J. C., & Savage, E.. (2018). Frameworks
for self-management support for chronic disease: a cross-country
comparative document analysis. BMC Health Services Research, 18(1).
https://doi.org/10.1186/s12913-018-3387-0

261. Coleman MT, Newton KS. Supporting self-management in patients with
chronic illness. Am Fam Physician. 2005 Oct 15;72(8):1503-10. PMID:
16273817.

265. World Health Organization. Regional Office for Europe, Slama-
Chaudhry, Anbreen & Golay, Alain. (2019). Patient education and
self-management support for chronic disease: methodology for
implementing patient-tailored therapeutic programmes. Public health
panorama, 5 (2-3), 357 - 361. World Health Organization. Regional
Office for Europe. https://apps.who.int/iris/handle/10665/330106.

267. Grady PA, Gough LL. Self-management: a comprehensive approach to
management of chronic conditions. Am J Public Health. 2014
Aug;104(8):e25-31. doi: 10.2105/AJPH.2014.302041. Epub 2014 Jun 12.
PMID: 24922170; PMCID: PMC4103232.

268. Self-Management Support
• Self-management support includes the following:
• Providing compassionate, patient-centered care.
• Involving the whole care team in planning, carrying out, and following up patient visits.
• Planning patient visits that focus on prevention and care management rather than critical or acute care.
• Involving the patient in goal setting
• Providing customized education and skills training, using materials appropriate for different cultures and
health literacy levels.
• Making referrals to community-based resources, such as programs that help patients quit smoking or
follow an exercise plan.
• Following up with patients through email, phone, text messaging, or mailings to support them taking
good care of themselves.

269. How Can Self-Management Support Be
Put Into Action?
• Gathering clinical data before a visit.
• Setting agendas for the visit.
• Helping patients set health goals.
• Developing action plans for achieving goals.
• Tracking health outcomes.
• Referring patients to community programs.

270. PROBLEM-SOLVING WORKSHEET

275. Adams, P., Murnane, E. L., Elfenbein, M.,
Wethington, E., & Gay, G..
(2017). Supporting the Self-Management
of Chronic Pain Conditions with Tailored
Momentary Self-Assessments.
https://doi.org/10.1145/3025453.3025832

279. Lightfoot, C. J., Nair, D., Bennett, P. N., Smith, A. C., Griffin, A.
D., Warren, M., & Wilkinson, T. J.. (2022). Patient Activation: The
Cornerstone of Effective Self-Management in Chronic Kidney
Disease?. Kidney and Dialysis, 2(1), 91–105.
https://doi.org/10.3390/kidneydial2010012

280. Figure 1.Core tasks and processes involved in effective self-management
(adapted from Corbin and Strauss and Lorig and Hoffman)

281. Overview of potential challenges, factors, and components to consider when developing interventions designed
to increase patient activation in CKD

282. Hibbard, J. H., Mahoney, E. R., Stockard, J., & Tusler, M.. (2005). Development and Testing
of a Short Form of the Patient Activation Measure. Health Services Research, 40(6p1), 1918–
1930. https://doi.org/10.1111/j.1475-6773.2005.00438.x

283. Devraj, R., & Wallace, L. S. (2013). Application of the content expert process to develop a clinically
useful low-literacy Chronic Kidney Disease Self-Management Knowledge Tool (CKD-SMKT). Research in
Social and Administrative Pharmacy, 9(5), 633-639. https://doi.org/10.1016/j.sapharm.2012.09.006

292. Self-management in chronic illness model
Udlis, K. A.. (2011). Self-management in chronic illness: concept and dimensional analysis. Journal
of Nursing and Healthcare of Chronic Illness, 3(2), 130–139. https://doi.org/10.1111/j.1752-
9824.2011.01085.x

293. Mona, J., Dosh, M., Al-Jibory, W. (2020). Proposed Improving Self-management Support System for Chronic Care Model (Heart
Diseases). In: Balas, V., Kumar, R., Srivastava, R. (eds) Recent Trends and Advances in Artificial Intelligence and Internet of Things.
Intelligent Systems Reference Library, vol 172. Springer, Cham. https://doi.org/10.1007/978-3-030-32644-9_24

302. Q & A