MacDonell R J
Respir Care. 1983 Feb;28(2):180-90.
The difficulties in delivering patient-care services in a pulmonary rehabilitation program (PRP), especially in a program with a multidisciplinary approach, can usually be overcome by first conceptualizing and then organizing the PRP within a human-service-agency framework. All human-service agencies have six service components in common. The following are the components and their applicability to the Harper Hospital (Detroit, Michigan) PRP: (1) Outreach and Referral--local physicians are informed of the program and asked to send referrals; (2) Intake--initial information about the patient is gathered and his initial eligibility for the program is determined; (3) Assessment--more information about the patient is obtained, all data are organized for easy use and accessibility, and a final determination of eligibility is made; (4) Service Planning--needed service consultations are determined and obtained; (5) Service Delivery--during which a respiratory therapist serves as coordinator of the linkage of the various service subsystems and facilitates communication among them; (6) Follow-Up and Maintenance--at 1-month, 3-month, 6-month, and 1-year intervals and after each rehospitalization. Through evaluation of the program process and the program outcomes, PRP administrators can modify PRP structure and staffing to enhance the effectiveness of service delivery.
在肺部康复项目（PRP）中，尤其是在采用多学科方法的项目中，提供患者护理服务存在诸多困难，而通过首先在人类服务机构框架内对PRP进行概念化，然后进行组织，这些困难通常是可以克服的。所有人类服务机构都有六个共同的服务组成部分。以下是这些组成部分及其对哈珀医院（密歇根州底特律）PRP的适用性：（1）外展与转诊——告知当地医生该项目并请求他们发送转诊患者；（2）接纳——收集患者的初始信息并确定其参加该项目的初始资格；（3）评估——获取更多关于患者的信息，整理所有数据以便于使用和获取，并最终确定资格；（4）服务规划——确定并获得所需的服务咨询；（5）服务提供——在此期间，呼吸治疗师担任各个服务子系统联系的协调员，并促进它们之间的沟通；（6）随访与维持——分别在1个月、3个月、6个月和1年的间隔时间以及每次再次住院后进行。通过对项目过程和项目结果的评估，PRP管理人员可以修改PRP的结构和人员配置，以提高服务提供的有效性。
