Skip to content

References: Patient Care Plans and Chronic Disease Management

  1. Nursing care plan - Wikipedia - Explains how a structured care plan captures assessment, goals, interventions, and evaluation, mirroring this chapter's CarePlan/Goal/Intervention subgraph pattern for Patient Care Plan, the chapter's highest-impact concept.

  2. Chronic care management - Wikipedia - Surveys models for coordinating long-term illness care, including the Chronic Care Model, directly supporting this chapter's description of chronic disease management as a recurring, cyclical loop of monitoring and adjustment.

  3. Biomarker - Wikipedia - Comprehensive coverage of biomarkers as measurable indicators of biological state, the generic category this chapter uses to unify lab results and vital signs under one shared graph modeling pattern.

  4. Chronic Illness Care: Principles and Practice (2nd ed., 2023) - Timothy P. Daaleman and Margaret R. Helton (eds.) - Springer - Credited for reframing Edward Wagner's Chronic Care Model into a widely-adopted, multi-level "ecological framework" (individual, family/community, social determinants, policy) that maps directly onto this chapter's ongoing chronic-disease-management loop.

  5. Designing Data-Intensive Applications - Martin Kleppmann - O'Reilly Media - Kleppmann is credited for the influential "the log is the database" explanation and event-sourcing diagrams showing immutable append-only history versus derived current state, the exact reasoning behind this chapter's versioned care plans and dated treatment-timeline events.

  6. About Chronic Diseases - Centers for Disease Control and Prevention - Explains the prevalence, risk factors, and public-health burden of chronic conditions such as diabetes and hypertension, grounding this chapter's Chronic Disease Management and Preventive Care sections in real population data.

  7. Care Management - Centers for Medicare & Medicaid Services - Describes Medicare's Chronic Care Management and Transitional Care Management billing services for patients with multiple chronic conditions, showing how this chapter's Patient Care Plan concept operates in real reimbursement policy.

  8. Laboratory Tests - MedlinePlus, National Library of Medicine - Patient-oriented explanation of how lab tests are ordered, performed, and interpreted, directly supporting this chapter's opening distinction between a Lab Test order and the Lab Result value it returns.

  9. PROMIS Overview - NIH Common Fund - Describes the Patient-Reported Outcomes Measurement Information System for assessing pain, fatigue, and quality of life across chronic diseases, the exact instrument this chapter names when introducing the Quality of Life Metric concept.

  10. Patient Journey - Neo4j Developer Guides - Worked Cypher examples modeling encounters, conditions, care plans, and comorbidities as a connected patient graph, closely paralleling this chapter's Patient Journey, Treatment Timeline, and Comorbidity graph patterns.