title: The eHealth Enhanced Chronic Care Model: a theory derivation approach.
abstract: BACKGROUND
  Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools.
  
  
  OBJECTIVE
  The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses.
  
  
  METHODS
  Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM.
  
  
  RESULTS
  We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider.
  
  
  CONCLUSIONS
  The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.
authors.affiliation: School of Nursing, Division of Health Sciences, Idaho State University, Pocatello, ID, United States. geeperr@isu.edu.
authors.forename: Perry M
authors.identifier: http://orcid.org/0000-0002-3107-2715
authors.initials: PM
authors.lastname: Gee
authors.forename: Deborah A
authors.identifier: http://orcid.org/0000-0002-7603-4624
authors.initials: DA
authors.lastname: Greenwood
authors.forename: Debora A
authors.identifier: http://orcid.org/0000-0001-8591-6875
authors.initials: DA
authors.lastname: Paterniti
authors.forename: Deborah
authors.identifier: http://orcid.org/0000-0002-3603-964X
authors.initials: D
authors.lastname: Ward
authors.forename: Lisa M Soederberg
authors.identifier: http://orcid.org/0000-0001-8261-1814
authors.initials: LM
authors.lastname: Miller
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D020000:Decision Support Systems, Clinical; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D012648:Self Care / Q000379:methods*; D060756:Social Networking; D017216:Telemedicine
keywords: chronic disease; eHealth; education of patients; mobile health; personal health records; social networks; telemedicine
references.citation: J Med Internet Res. 2012 Feb 21;14(1):e32
references.pmid: 22353433
references.citation: J Am Med Inform Assoc. 2006 Mar-Apr;13(2):121-6
references.pmid: 16357345
references.citation: PLoS One. 2013;8(3):e59707
references.pmid: 23527256
references.citation: J Diabetes Sci Technol. 2010 Mar 01;4(2):470-5
references.pmid: 20307409
references.citation: Curr Diab Rep. 2012 Dec;12(6):769-81
references.pmid: 22949135
references.citation: Diabetes Care. 2006 Apr;29(4):811-7
references.pmid: 16567820
references.citation: J Health Commun. 2012;17(8):960-78
references.pmid: 22574697
references.citation: J Med Libr Assoc. 2009 Jan;97(1):12-20
references.pmid: 19159002
references.citation: JAMA. 2014 May 14;311(18):1851-2
references.pmid: 24664278
references.citation: BMJ. 2004 May 15;328(7449):1148-9
references.pmid: 15142894
references.citation: Evid Rep Technol Assess (Full Rep). 2012 Jun;(206):1-1531
references.pmid: 24422882
references.citation: J Med Internet Res. 2014 Nov 10;16(11):e225
references.pmid: 25386719
references.citation: Health Serv Res. 2004 Aug;39(4 Pt 1):1005-26
references.pmid: 15230939
references.citation: Telemed J E Health. 2014 Sep;20(9):828-34
references.pmid: 25061688
references.citation: Health Aff (Millwood). 2009 Jan-Feb;28(1):75-85
references.pmid: 19124857
references.citation: CMAJ. 2009 Jul 7;181(1-2):37-44
references.pmid: 19581618
references.citation: N Engl J Med. 2010 Aug 5;363(6):501-4
references.pmid: 20647183
references.citation: Telemed J E Health. 2014 May;20(5):409-18
references.pmid: 24502793
references.citation: J Diabetes Sci Technol. 2014 Feb 21;8(2):378-389
references.pmid: 24876591
references.citation: JAMA Intern Med. 2013 Mar 11;173(5):345-51
references.pmid: 23400234
references.citation: J Hum Nutr Diet. 2015 Feb;28 Suppl 2:1-15
references.pmid: 24480032
references.citation: Nurs Outlook. 2012 Jul-Aug;60(4):e9-16
references.pmid: 22221955
references.citation: J Aging Health. 2012 Apr;24(3):525-41
references.pmid: 22187092
references.citation: JAMA. 2002 Oct 16;288(15):1909-14
references.pmid: 12377092
references.citation: J Healthc Inf Manag. 2007 Winter;21(1):76-86
references.pmid: 17299929
references.citation: Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
references.pmid: 11816692
references.citation: J Am Med Inform Assoc. 2002 May-Jun;9(3):255-61
references.pmid: 11971886
references.citation: Diabetes Educ. 2006 Mar-Apr;32(2):253-60
references.pmid: 16554429
references.citation: J Med Syst. 2012 Jun;36(3):1043-52
references.pmid: 20703633
references.citation: J Med Internet Res. 2013 May 02;15(5):e93
references.pmid: 23639979
references.citation: Med Care. 2013 Mar;51(3 Suppl 1):S62-6
references.pmid: 23407015
references.citation: Ann Fam Med. 2010 Sep-Oct;8(5):410-7
references.pmid: 20843882
references.citation: Perspect Health Inf Manag. 2012;9:1f
references.pmid: 22783154
references.citation: Cochrane Database Syst Rev. 2012 Dec 12;12:CD007459
references.pmid: 23235644
references.citation: J Gen Intern Med. 2005 Jan;20(1):52-7
references.pmid: 15693928
references.citation: J Med Internet Res. 2013 Feb 14;15(2):e35
references.pmid: 23410671
references.citation: J Biomed Inform. 2013 Dec;46(6):957-69
references.pmid: 23702104
references.citation: N Engl J Med. 2011 Dec 22;365(25):2426-31
references.pmid: 22187990
references.citation: Australas Med J. 2012;5(9):517-21
references.pmid: 23115588
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):323-33
references.pmid: 19275987
references.citation: J Gen Intern Med. 2012 May;27(5):520-6
references.pmid: 22127797
references.citation: J Med Internet Res. 2013 Feb 20;15(2):e37
references.pmid: 23425685
references.citation: J Med Internet Res. 2010 Dec 17;12(4):e71
references.pmid: 21169160
references.citation: J Med Internet Res. 2013 Mar 11;15(3):e53
references.pmid: 23478028
references.citation: Health Educ Behav. 2009 Dec;36(6):1065-81
references.pmid: 19834054
references.citation: J Med Internet Res. 2013 Apr 23;15(4):e85
references.pmid: 23615206
references.citation: ANS Adv Nurs Sci. 2011 Jan-Mar;34(1):6-18
references.pmid: 21150551
references.citation: J Med Internet Res. 2010 Dec 19;12(5):e63
references.pmid: 21172765
references.citation: J Gen Intern Med. 2011 Mar;26(3):287-92
references.pmid: 20945113
references.citation: AMIA Annu Symp Proc. 2008 Nov 06;:1182
references.pmid: 18999142
references.citation: Eff Clin Pract. 1998 Aug-Sep;1(1):2-4
references.pmid: 10345255
references.citation: J Med Internet Res. 2005 Feb 24;7(1):e1
references.pmid: 15829471
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1290-5
references.pmid: 16162575
references.citation: Ann Intern Med. 2013 Nov 19;159(10):677-87
references.pmid: 24247673
references.citation: Semin Oncol Nurs. 2011 Aug;27(3):169-82
references.pmid: 21783008
references.citation: J Biomed Inform. 2010 Oct;43(5 Suppl):S3-S5
references.pmid: 20937482
references.citation: Palliat Med. 2013 Feb;27(2):179-84
references.pmid: 22179597
references.citation: Patient. 2009 Dec 1;2(4):257-68
references.pmid: 22273246
references.citation: J Am Med Inform Assoc. 2013 May 1;20(3):526-34
references.pmid: 23171659
references.citation: J Med Internet Res. 2001 Apr-Jun;3(2):E20
references.pmid: 11720962
references.citation: Med Care. 2014 Mar;52(3):194-201
references.pmid: 24374412
references.citation: Prev Chronic Dis. 2014 Apr 17;11:E62
references.pmid: 24742395
references.citation: Telemed J E Health. 2013 Aug;19(8):573-8
references.pmid: 23742629
references.citation: Evid Rep Technol Assess (Full Rep). 2008 Nov;(175):1-1422
references.pmid: 19408968
references.citation: Health Aff (Millwood). 2014 Feb;33(2):251-7
references.pmid: 24493768
references.citation: Diabetes Educ. 2005 Mar-Apr;31(2):225-34
references.pmid: 15797851
references.citation: Am J Manag Care. 2011 Apr;17(4):e104-20
references.pmid: 21774099
references.citation: J Am Med Inform Assoc. 2003 May-Jun;10(3):260-70
references.pmid: 12626378
references.citation: Fam Med. 2008 Jun;40(6):423-32
references.pmid: 18773781
references.citation: Am J Prev Med. 2004 Apr;26(3):237-42
references.pmid: 15026105
references.citation: J Med Internet Res. 2011 Dec 23;13(4):e125
references.pmid: 22193243
references.citation: J Gerontol B Psychol Sci Soc Sci. 2010 May;65B(3):390-9
references.pmid: 19541672
references.citation: J Am Med Inform Assoc. 2008 Nov-Dec;15(6):729-36
references.pmid: 18756002
references.citation: J Am Med Inform Assoc. 2011 Jul-Aug;18(4):515-22
references.pmid: 21672914
references.citation: J Med Internet Res. 2005 Mar 31;7(1):e9
references.pmid: 15829481
references.citation: Natl Vital Stat Rep. 2012 Oct 10;61(6):1-51
references.pmid: 24984457
references.citation: J Am Med Inform Assoc. 2010 Mar-Apr;17(2):192-5
references.pmid: 20190063
references.citation: NCHS Data Brief. 2014 Jan;(143):1-8
references.pmid: 24439138
references.citation: Med Decis Making. 2001 Jan-Feb;21(1):37-44
references.pmid: 11206945
references.citation: Am J Manag Care. 2005 Aug;11(8):478-88
references.pmid: 16095434
references.citation: Prev Chronic Dis. 2013;10:E26
references.pmid: 23428085
references.citation: J Med Internet Res. 2013 Mar 27;15(3):e65
references.pmid: 23535584