The Chronic Care Model has been found to be useful in a wide range of settings for different populations. Teams working with unique groups may need to emphasize some model elements more than others. For example, Self-Management is very important migrant populations who may seek health care in several geographic areas, while Community linkages are crucial when working with homeless populations. In some cases, adaptation of key changes will be necessary such as using pictorial educational information for populations with low literacy.

Consider the following changes for improving asthma care when applying the Chronic Care Model to special organizational settings or patient populations.

Uninsured Patients

Self-Management:

• Find free educational materials and/or free self-management classes in the community.
• Obtain free transportation to self-management classes (bus, volunteer drivers, taxi vouchers, etc.).

Decision Support:

• Know whether insurance pays for certain diagnostic tests, medications, and referrals to specialists.
• Once the severity of a patient's condition is established, use alternative ways to do follow-up assessments (e.g., phone) to determine whether a patient needs to come in.
• Develop a medication list with costs for providers so they can help choose a medication that the patient can afford.

Clinical Information System:

• Link patient by insurance company. If the patient is uninsured, link with available resources. 

Delivery System Design:

• Provide appropriate subspecialty care at the primary care level.

Community:

• Utilize compassionate use programs and/or seek industry-sponsored support for medication and supplies otherwise unavailable to patients without insurance coverage. Sometimes specialists will offer their services free of charge.

Population (migrant, homeless, language, race/culture, age, socioeconomic)

Self-Management:

• Customize materials appropriate to the population served (illustrate, translate into different languages).

Clinical Information System:

• Track migrant population over years.

Delivery System Design:

• Customize materials appropriate to the population served (illustrate, translate into different languages).
• Hire staff and train local staff from the community served.

Community:

• (Age) Use day care centers and preschools for identifying very young children with asthma.
• Find local faith groups to build support for changes.

Independent Practice vs. Integrated Delivery Network (IDN)

Decision Support:

• Use existing incentives to alter practice patterns in recommended directions, whenever possible.

Clinical Information System:

• Use ER, hospital, and pharmacy data to inform and populate the registry.
• NOTE: Because IDNs are closed organizational systems, it is often possible to track medications, hospitalizations, and emergency room utilization by individual patient. This is a tremendous resource that should be utilized whenever possible.