Toolkit for Implementing the Chronic Care Model in an Academic Environment

Collaborative Care Manager Model

The Collaborative Care Manager Model shows the relationships between the nurse practitioner, resident, clinical expert, and patient.

Diagram of the Collaborative Care Manager Model. For details, see Text Description below.

Text Description

The Collaborative Care Manager Model shows the relationships between the Nurse Practitioner, Resident, Clinical Expert and Patient. There is a large circle with one smaller circle at the top, one circle at the bottom to the left and one circle at the bottom to the right. Another circle is in the center.

The top circle represents the Nurse Practitioner, who manages planned visits, updates the care process, trains residents, and activates patients. In the circle at the bottom and the left is the Resident, who learns to intensify care, coach self-care goals, oversee the medical care, and work in a team. In the circle to the bottom right is the Clinical Expert, who leads the team meetings, intensifies care, trains resident, and assumes accountability. In the center is the circle representing the Patient, who sets goals, develops skills, and assumes self care.

In the larger circle linking these other circles is written "Interdisciplinary Care Team: Pharmacist, Nutiritionist, Social Worker, Psychologist, Podiatrist, Opthalmologist." There are three double-sided arrows in the larger circle. One points to the Resident Circle and Nurse Practitioner Circle. Another points to the Nurse Practitioner Circle and Clinical Expert Circle. The third points to Resident Circle and Clinical Expert Circle.

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Page last reviewed October 2014
Page originally created January 2008
Internet Citation: Collaborative Care Manager Model. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.