International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 44-51 http://medscipublisher.com/index.php/ijccr 45 This study explores how to optimize the management of chronic diseases among the elderly through a community health assessment system. It aims to identify effective strategies that can be applied in community settings to enhance disease self-management, improve health outcomes, and alleviate the burden on healthcare systems. By analyzing existing models and their results, this study seeks to provide actionable insights that can guide policy and healthcare practices. The significance of this research lies in its potential to contribute to sustainable health interventions that support the aging population, improve patient quality of life, and promote efficient resource utilization. 2 Overview of Community Health Assessment Systems 2.1 Definition and functions of community health assessment systems, such as health monitoring and check-ups Community health assessment systems are comprehensive frameworks designed to evaluate and monitor the health of community members, focusing particularly on the elderly (Sendall et al., 2016). These systems include functions such as routine health monitoring, periodic check-ups, and data collection to track vital health metrics. The primary function of these systems is to enable early detection of health issues, thereby facilitating timely intervention and preventing complications related to chronic conditions. By supporting continuous assessment, these systems contribute to enhanced preventive care, which is crucial for reducing chronic disease progression and healthcare costs (Wu et al., 2021). 2.2 Key components and implementation steps of the system The core components of community health assessment systems include data collection mechanisms, standardized health evaluation protocols, health analytics tools, and communication platforms (Seixas et al., 2020). Data collection is typically conducted through electronic health records (EHRs), wearable health devices, and mobile applications. Health analytics tools help in analyzing patient data to identify patterns and forecast potential health issues, while communication platforms ensure smooth coordination between healthcare providers, patients, and caregivers (Haldane et al., 2019). Implementation steps involve establishing collaborative partnerships with local healthcare providers, training healthcare personnel, and integrating patient education into the management process to foster self-care and engagement (Figure 1) (Liu and Wu, 2023). Figure 1 Community health assessment system components and implementation steps (Adopted from Liu and Wu, 2023) 2.3 Potential applications and advantages of the system in managing chronic diseases among the elderly The application of community health assessment systems in chronic disease management offers multiple advantages. These systems support proactive disease management by enabling continuous health monitoring, which can lead to early detection of issues and timely medical response (McKillop et al., 2017; Kangovi et al., 2018). This proactive approach helps minimize disease complications and supports better long-term outcomes for elderly patients (Gibbs et al., 2021). Additionally, these systems enhance patient engagement by providing tailored feedback and educational resources that empower patients to take an active role in managing their health, improving adherence to treatment plans (Wu et al., 2022). Community health assessment systems also contribute to optimizing healthcare resources by reducing the frequency of unnecessary hospital visits and streamlining the care process, which helps alleviate the pressure on healthcare facilities and ensures that resources are used more efficiently (Yao and Cao, 2021).
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