Dant T, Gearing B
Department of Health and Social Welfare, Open University.
J Soc Policy. 1990 Jul;19(3):331-60. doi: 10.1017/s0047279400018067.
In the United Kingdom a range of services for elderly people in the community has developed that is delivered by a variety of professionals and administered within different organisations. This has resulted in a problem of co-ordinating services to meet the individual needs of the most frail elderly people. In the United States 'case management' has been introduced as a way of improving the co-ordination of care. Despite structural differences in the provision of health and social services between the United States and the United Kingdom, the concept of case management has influenced the design of a number of innovatory schemes in the United Kingdom, including the Gloucester Care for Elderly People at Home project (CEPH). These innovatory schemes have demonstrated the need for a 'keyworker' and clarified the tasks that are involved in taking responsibility for co-ordinating services to meet the needs of elderly people at risk of failing to cope at home. There is, however, a danger of proliferating the complexity of service provision by creating a new breed of professional; an alternative might be to alter the responsibilities, attitudes and team orientation of existing professional workers so as to include taking on the keyworker role for some of their clients.
在英国，已经发展出一系列针对社区老年人的服务，这些服务由各类专业人员提供，并在不同组织内进行管理。这就导致了一个问题，即如何协调服务以满足最体弱老年人的个人需求。在美国，“病例管理”已被引入，作为改善护理协调的一种方式。尽管美国和英国在卫生与社会服务的提供结构上存在差异，但病例管理的概念已影响了英国一些创新计划的设计，包括格洛斯特居家照顾老年人项目（CEPH）。这些创新计划表明需要一名“关键工作者”，并明确了负责协调服务以满足有在家无法自理风险的老年人需求所涉及的任务。然而，存在一种风险，即通过创造一类新的专业人员来增加服务提供的复杂性；另一种选择可能是改变现有专业工作人员的职责、态度和团队导向，以便让他们中的一些人承担起为部分客户担任关键工作者的角色。
