Abstract: Objective: To explore the application of case management model based on a chronic disease management APP and to provide evidence for the innovation of case management. Methods: The integrated, cross-disciplinary case management team model was performed to an elderly patient with multiple chronic diseases after Percutaneous Coronary Intervention (PCI) through independent-developed APP of chronic disease management with wearable devices. Results: During a 3-month period of case management, the case management team identified and dealt with 2 times abnormal condition changes. No complications such as myocardial infarction and unexpected emergency or re-hospitalization occurred. All the management objectives were achieved. Conclusion: Case management model based on chronic disease management APP could give full play to the advantages of both m-health and case management and promote high quality and cost-effective service, which is worth popularizing.