title: [Optimization of the care process for chronic diseases: the Chronic Care Model].
authors.affiliation: H:S Bispebjerg Hospital, Klinisk Enhed for Sygdomsforebyggelse København. af12@bbh.hosp.dk
authors.forename: Anne
authors.initials: A
authors.lastname: Frølich
authors.forename: Carsten
authors.initials: C
authors.lastname: Hendriksen
authors.forename: Svend Juul
authors.initials: SJ
authors.lastname: Jørgensen
mesh_terms: D002908:Chronic Disease / Q000534:rehabilitation*; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards; D003657:Decision Making; D003718:Denmark; D019468:Disease Management; D006801:Humans; D033183:Interdisciplinary Communication; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning / Q000458:organization & administration / Q000592:standards; D010353:Patient Education as Topic / Q000458:organization & administration / Q000592:standards; D012648:Self Care