Health Promotion Practice November 2014 Vol. 15, Suppl 2 23S–28S DOI: 10.1177/1524839914544171 © 2014 Society for Public Health Education 23S Commentary The chronic care model (CCM) has been initiated most frequently in clinical settings with outreach to the community to obtain involvement and guidance. Implementation of the CCM by communities that reach out to clinicians and develop linkages and coor- dination to improve care for community members with chronic conditions is less frequently observed. This commentary describes the implementation of the CCM by the Eastern Shoshone Tribe of the Wind River Indian Reservation. The design emphasized commu- nity-based leadership, with the Tribe having the pri- mary role in developing and implementing culturally tailored community self-management supports, improving linkages with Indian Health Service (IHS) clinicians and cultural knowledge of providers, and developing a coalition of organizations with addi- tional resources to create a more comprehensive sys- tem of diabetes care for Tribal members with diabetes. Results indicate that community-initiated imple- mentation of the CCM can be an effective strategy for creating a comprehensive community-clinical system of care for community members with diabetes. Overall, by the fourth implementation year, approximately 25% of Tribal members with diabetes had partici- pated in the program and 28% of people on the Diabetes Registry had HbA1c levels above 9.0 com- pared to 32% before the Wind River ARDD program. The success of the Wind River program suggests that community-driven approaches are a valuable strategy in our nation’s efforts to eliminate health disparities and ensure equal and fair access to qual- ity health care for all citizens. Keywords: behavior change; diabetes; chronic dis- ease; community intervention; American Indian/Alaska Native; minority health T he chronic care model (CCM) is an organiza- tional approach to improving care for people with chronic disease—such as diabetes—through involving the community, health system, and patients in a collaboration that provides support, information and education, and health care (Wagner et al., 2001). Most frequently, the model has been initiated in clinical settings with outreach to the community to obtain involvement and guidance (Coleman, Austin, Brach, & 544171HPP XX X 10.1177/1524839914544171HEALTH PROMOTION PRACTICE / Month XXXXLangwell et al. / AMERICAN INDIAN COMMUNITY IMPLEMENTS CHRONIC CARE MODEL research-article 2014 1 Sundance Research Institute, Sundance, WY, USA 2 Eastern Shoshone Tribal Health Director, Fort Washakie, WY, USA 3 Econometrica, Inc., Bethesda, MD, USA Authors’ Note: Address correspondence to Kathryn Langwell, Project Evaluator, President, Sundance Research Institute, P.O. Box 874, 10 Sundance Kid Circle, Sundance, WY 82729, USA; e-mail: klangwell@sundanceresearchinstitute.org. Supplement Note: This article is part of a journal supplement titled “The Alliance to Reduce Disparities in Diabetes: Infusing Policy and System Change With Local Experience.” The supplement was supported by a grant to the Society for Public Health Education from the Merck Foundation. The Merck Foundation had no role in the development, writing, editing, review, or approval of the content of any of the articles in this issue. An American Indian Community Implements the Chronic Care Model: Evolution and Lessons Learned Kathryn Langwell, MA 1 Catherine Keene, MBA 2 Matthew Zullo, MA 1 Linda Chioma Ogu, MPH 3 by guest on February 14, 2015 hpp.sagepub.com Downloaded from