Connecting Care (Severe Chronic Disease Management) Program
Mission Statement | Key FeaturesMission Statement
The Connecting Care (Severe Chronic Disease Management) Program's mission is to deliver more effective health management for people aged 16 years and over with chronic diseases covered by the Program at very high risk or high risk of unplanned hospital or Emergency Department presentation.
The Program's targets to enrol 43,000 over the next four years to present a new model of joined and shared care across the New South Wales state. This program will deliver integrated, patient focussed, whole person approach when addressing patient clinical and non clinical functional deficits.
Key Features
- Priority of five diseases, namely Diabetes, Congestive Heart Failure, Coronary Artery Diseases, Chronic Obstructive Pulmonary Disease and Hypertension.
- A proactive, coordinated approach to chronic disease management.
- Proactive identification,assessment, enrolment and monitoring.
- Strong support for multidisciplinary care, care planning and care coordination.
- Recognition of General Practitioners as main medical care provider.
- Strong support for patient self-management.
- New regional Chronic Disease Management Services.
- New information and communication technology systems.
- New Statewide Health Contact Centre capacity.
- New funding, organisational and governance structure.