Ontario Ministry of Health and Long-Term Care.

The Ontario Ministry in 2007 proposed a conceptual model for preventing and managing chronic disease. 

Ontario MOH chronic disease prevention model

" The Framework identifies a cluster of practice and system changes like those in the US Chronic Care Model that have been found to improve chronic care delivery. The elements, such as personal skills and self-management support, delivery system design, provider decision support, information systems, are essential to good care... The elements are interconnected and mutually dependent. ... Changing delivery of care to improve outcomes requires fundamental system changes in the design of practice and provision of self-management supports. The Framework is a ‘roadmap’ to a chronic care delivery system that provides effective care and better health outcomes. Each ‘stop’ on the roadmap is linked to other stops. The Framework can be applied to both specific and generic chronic disease practice, and to different types of health care organizations."