Bodenheimer Thomas, Wagner Edward H, Grumbach Kevin
Family and Community Medicine, University of California, San Francisco, USA.
JAMA. 2002 Oct 16;288(15):1909-14. doi: 10.1001/jama.288.15.1909.
This article reviews research evidence showing to what extent the chronic care model can improve the management of chronic conditions (using diabetes as an example) and reduce health care costs. Thirty-two of 39 studies found that interventions based on chronic care model components improved at least 1 process or outcome measure for diabetic patients. Regarding whether chronic care model interventions can reduce costs, 18 of 27 studies concerned with 3 examples of chronic conditions (congestive heart failure, asthma, and diabetes) demonstrated reduced health care costs or lower use of health care services. Even though the chronic care model has the potential to improve care and reduce costs, several obstacles hinder its widespread adoption.
本文回顾了研究证据，这些证据表明慢性病护理模式在何种程度上能够改善慢性病管理（以糖尿病为例）并降低医疗成本。39项研究中的32项发现，基于慢性病护理模式要素的干预措施至少改善了糖尿病患者的1项流程或结果指标。关于慢性病护理模式干预措施能否降低成本，27项涉及3种慢性病实例（充血性心力衰竭、哮喘和糖尿病）的研究中有18项表明医疗成本降低或医疗服务使用减少。尽管慢性病护理模式有改善护理和降低成本的潜力，但仍有几个障碍阻碍其广泛采用。
