The Expanded Chronic Care Model

Contributor: Rosemary Eustace (Nursology Management Team)
May 30, 2021

Author: Victoria J. Barr, PhD

Additional Contributors:

Sylvia Robinson, MPH, Brenda Marin-Link, RN, MBA, Lisa Underhill, RN, MN, Anita Dotts, RN, BScN, Darlene Ravensdale, RD, MSc, and Sandy Salivaras, BA

Year First Published: 2003
Major Concepts
  • Health System Organization of Healthcare
  • Self-Management Support
  • Decision Support
  • Delivery System Design
  • Clinical Information System
  • Community Resources and Policies
Typology: Shared Middle Range Conceptual Model
Brief Description

The Expanded Chronic Care Model (Expanded CCM) presents a systematic way of understanding health care team efforts to reduce the burden of chronic diseases among patients living with the disease and also supporting people and communities to be healthy. See  [See: Healthcare Quarterly ]. The model is derived from the Chronic Care Model (CCM) developed by Wagner (1998), a physician with training in medicine and public health. [See:  Improving Chronic Care Organization.] The original CCM has been implemented by a larger number of health care organizations worldwide with positive outcomes (Wagner et al. 2001). Both the CCM and ECCM have been applied in variety of nursing situations and problems in chronic disease management such as diabetes, heart failure, HIV/AIDS patient care. The ECCM broadens the CMM by integrating population health promotion and developing the community to address health determinants. One similar model that emphasize the broader community and policy environment is the World Health Organization (2002) Innovative Care for Chronic Conditions (ICCC) model.

The ECCM is considered a nursing shared model. Continued adoption of the CCM and ECCM models in nursology is relevant for developing shared models/theories.The ECCM’s community and population health foci are important to nursologists. Besides providing a basis to recognizing the need to strengthen the public health infrastructure and the role of the public health nurses in nursing and healthcare systems (Kulbok, Thatcher, Park, Meszaros, 2012); Kub, Kulbok, Miner, & Merrill, 2017), the model is useful in guiding the design, implementation and evaluation of new organizational nurse-led shared models of care in disease prevention and management at various health care systems. 


Kub, J. E., Kulbok, P. A., Miner, S., & Merrill, J. A. (2017). Increasing the capacity of public health nursing to strengthen the public health infrastructure and to promote and protect the health of communities and populations. Nursing outlook65(5), 661-664.

Kulbok, P.A., Thatcher, E., Park, E., Meszaros, P.S. (May 31, 2012) “Evolving Public Health Nursing Roles: Focus on Community Participatory Health Promotion and Prevention” OJIN: The Online Journal of Issues in Nursing, 17(2). 1. https://10.3912/OJIN.Vol17No02Man01

World Health Organization (2002). Innovative care for chronic conditions: building blocks for action. Global report (document no. WHO/NMC/CCH/0201).  Retrieved from

Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1(1), 2-4.

Wagner, E. H., R. Glasgow, C. Davis, A. Bonomi, L. Provost, D. McCulloch, P. Carver and C. Sixta. 2001. Quality Improvement in Chronic Illness Care: A Collaborative Approach. Journal on Quality Improvement, 27(2), 63-80.

About Victoria J. Barr

The Expanded Chronic Care Model (ECCM) was developed in 2003 by an interprofessional healthcare team led by Dr Victoria Barr of the University of British of Victoria, British Columbia, Canada. Her educational background is in health promotion and community planning. She is an Adjunct Professor in the School of Public Health & Social Policy at the University of Victoria and also a Community Health & Equity Consultant at the LevelUp Planning & Consulting.