Sidorov Jaan, Shull Robert D, Girolami Sabrina, Mensch Debra
Care Coordination Program, Geisinger Health Plan, Hughes Office Building 1st Floor, Danville, PA 17822-3020, USA.
Dis Manag. 2003 Summer;6(2):111-7. doi: 10.1089/109350703321908496.
While disease management has been described as an important strategy for the care of patients with congestive heart failure (CHF) in the managed care setting, little is known about the impact of this approach on overall health-related quality of life. In this study the Short Form 36 (SF-36) was administered to all patients entering CHF disease management at the time of program entry and at 1 year following entry. Scores on the eight subscales and the two composite scales were calculated and compared before and after. Patients were enrolled from a mixed-model health maintenance organization (HMO) with 34,740 Medicare + Choice enrollees residing in 38 counties in central and northeastern Pennsylvania. Two hundred sixty-eight continuously enrolled patients in an HMO-sponsored CHF disease state management program with completed baseline and follow-up SF-36 surveys were sampled. All patients entered into disease management received primary care based, nurse-directed education about CHF self-management including instruction on etiology of CHF, the importance of medication compliance, home care services if indicated, monitoring weight gain, increased understanding of the warning signs of worsening CHF, and coaching on strategies to contact a physician in a timely manner when CHF worsens. Nurses also facilitated for CHF guidelines among primary care physicians, including the need to obtain a baseline assessment of cardiac function, prescribe angiotensin I-converting enzyme (ACE) inhibitors and beta blockers when appropriate, and initiated appropriate specialist referral. Compared with enrollees who did not complete a pair of SF-36 surveys, the 268 respondents were younger and had a significantly higher rate of cardiac imaging as well as use of ACE inhibitors and beta blocker medications. Analysis of the SF-36 data revealed that three of the eight (Role Physical, General Health Perceptions, and Role Emotional) subscales increased in a statistically significant manner, as did the Mental Health Composite Score. No statistically significant declines in SF-36 scores were observed. Despite limitations to our study, we found disease management for patients with CHF can be associated with significant improvements in quality of life as measured by the SF-36. Compared with nonrespondents, respondents had a higher prevalence of cardiac imaging, ACE inhibitor use, and beta blocker medication use. Our findings are also limited by a lack of a control group with the possibility that the improvements we observed were unrelated to the disease management intervention. However, our findings and success with the use of this tool indicate the SF-36 can be an important part of the ongoing assessment of patients in a disease management program for CHF.
虽然疾病管理已被描述为管理式医疗环境中治疗充血性心力衰竭（CHF）患者的一项重要策略，但对于这种方法对整体健康相关生活质量的影响却知之甚少。在本研究中，对所有进入CHF疾病管理项目的患者在项目开始时和开始后1年进行了简短健康调查问卷（SF - 36）评估。计算并比较了八个分量表和两个综合量表在前后的得分。患者来自一个混合模式的健康维护组织（HMO），该组织在宾夕法尼亚州中部和东北部的38个县有34,740名医疗保险 + 选择计划的参保人。从一个由HMO赞助的CHF疾病状态管理项目中连续登记的、完成了基线和随访SF - 36调查的268名患者中进行抽样。所有进入疾病管理项目的患者都接受了以初级保健为基础、由护士指导的关于CHF自我管理的教育，包括CHF病因的指导、药物依从性的重要性、如有需要的家庭护理服务、监测体重增加、增强对CHF病情恶化警示信号的理解，以及关于CHF病情恶化时及时联系医生的策略指导。护士还促进了初级保健医生遵循CHF治疗指南，包括需要对心脏功能进行基线评估、在适当的时候开血管紧张素转换酶（ACE）抑制剂和β受体阻滞剂，并启动适当的专科转诊。与未完成一对SF - 36调查的参保人相比，这268名受访者更年轻，心脏成像以及使用ACE抑制剂和β受体阻滞剂药物的比例明显更高。对SF - 36数据的分析显示，八个分量表中的三个（身体功能、总体健康感知和情感功能）以及心理健康综合得分有统计学意义的增加。未观察到SF - 36得分有统计学意义的下降。尽管我们的研究存在局限性，但我们发现，以SF - 36衡量，CHF患者的疾病管理可带来生活质量的显著改善。与未回应者相比，回应者心脏成像、使用ACE抑制剂和使用β受体阻滞剂药物的患病率更高。我们的研究结果还受到缺乏对照组的限制，我们观察到的改善有可能与疾病管理干预无关。然而，我们的研究结果以及使用该工具的成功表明，SF - 36可以成为CHF疾病管理项目中对患者进行持续评估的重要组成部分。
