Trisolini Michael, Roussel Amy, Zerhusen Eileen, Schatell Dorian, Harris Shelly, Bandel Karen, Salib Philip, Klicko Kristi
Research Triangle Institute, 411 Waverley Oaks Road, Suite 330, Waltham, Massachusetts 02452, USA.
Int J Integr Care. 2004;4:e17. doi: 10.5334/ijic.114. Epub 2004 Oct 15.
To describe the potential role of the Internet as a vehicle for improving integration of care through activating chronic kidney disease patients and their family members. Also, to describe how that potential is being developed through a website sponsored by the Medicare program in the United States.
The Internet is expanding at a rapid rate, and health-related websites are one of its most popular features. Efforts to promote integration of care have focused mainly on providers up to now, and more emphasis is needed on the potential roles of patients. Chronically ill patients have particular needs for improved education about their conditions and enhanced involvement in care planning and treatment decisions. Medicare developed the Dialysis Facility Compare website to serve those goals for people with chronic kidney disease.
We conducted qualitative research with 140 chronic kidney disease patients and family members, and 130 renal care professionals to evaluate and improve the Dialysis Facility Compare website. A series of 19 focus groups, 13 triads (small focus groups), and 56 individual interviews were conducted in four regions of the United States and by telephone.
We found that the Dialysis Facility Compare website has the potential to improve integration of care for people with chronic kidney disease in at least three ways. First: by expanding the roles of patients as members of the multi-disciplinary team of caregivers treating their disease. Second: through better integration of the informal care provided in the home and community with the formal care provided by health professionals. Third: by improving coordination of between care provided in the pre-dialysis and dialysis phases of the disease.
We developed recommendations for revising and enhancing the Dialysis Facility Compare website in a number of ways to better promote patient activation and integration of care. The unique features of the Internet, such as its different dimensions of interactivity, and applications of behavioural theories for website design should also be further explored.
描述互联网作为一种工具，通过激励慢性肾病患者及其家庭成员来改善医疗整合的潜在作用。同时，描述美国医疗保险计划赞助的一个网站是如何开发这种潜力的。
互联网正在迅速发展，与健康相关的网站是其最受欢迎的功能之一。到目前为止，促进医疗整合的努力主要集中在医疗服务提供者身上，而患者的潜在作用需要更多关注。慢性病患者对改善病情教育以及更多参与护理计划和治疗决策有着特殊需求。医疗保险计划开发了“透析机构比较”网站，以服务于慢性肾病患者的这些目标。
我们对140名慢性肾病患者及其家庭成员以及130名肾脏护理专业人员进行了定性研究，以评估和改进“透析机构比较”网站。在美国的四个地区并通过电话进行了一系列19个焦点小组、13个三人小组（小型焦点小组）和56次个人访谈。
我们发现“透析机构比较”网站至少可以通过三种方式改善慢性肾病患者的医疗整合。第一：通过扩大患者作为治疗其疾病的多学科护理团队成员的作用。第二：通过更好地整合家庭和社区提供的非正式护理与卫生专业人员提供的正式护理。第三：通过改善疾病透析前和透析阶段所提供护理之间的协调。
我们提出了一些建议，以多种方式修订和改进 “透析机构比较” 网站，以更好地促进患者参与和医疗整合。互联网的独特特征，如不同维度的交互性，以及行为理论在网站设计中的应用，也应进一步探索。
