Rea Harry, Kenealy Tim, Wellingham John, Moffitt Allan, Sinclair Gary, McAuley Sue, Goodman Meg, Arcus Kim
Department of Medicine, University of Auckland, Auckland.
N Z Med J. 2007 Apr 13;120(1252):U2489.
Despite anecdotes of many chronic care management and integrated care projects around New Zealand, there is no formal process to collect and share relevant learning within (but especially between) District Health Boards (DHBs). We wish to share our experiences and hope to stimulate a productive exchange of ongoing learning. We define chronic care management and integrated care, then summarise current theory and evidence. We describe national policy development (relevant to integrated care, since 2000) including the New Zealand Health Strategy, the NZ Primary Care Strategy, the development of Primary Health Organisations (PHOs), capitation payments, Care Plus, and Services to Improve Access funding. We then describe chronic care management in Counties Manukau, which evolved both prior to and during the international refinement of theory and evidence and the national policy development and implementation. We reflect on local progress to date and opportunities for (and barriers to) future improvements, aided by comparative reflections on the United Kingdom (UK). Our most important messages are addressed as follows: To policymakers and funders--a fragile culture change towards teamwork in the health system is taking place in New Zealand; this change needs to be specifically and actively supported. To PHOs--general practices need help to align their internal (within-practice) financial signals with the new world of capitation and integrated care. To primary and secondary care doctors, nurses, and other carers - systematic chronic care management and integrated care can improve patient quality of life; and if healthcare structures and systems are properly managed to support integration, then healthcare provider professional and personal satisfaction will improve.
尽管新西兰各地有许多关于慢性病护理管理和综合护理项目的传闻，但在地区卫生委员会（DHBs）内部（尤其是之间），没有正式的流程来收集和分享相关经验教训。我们希望分享我们的经验，并希望促进正在进行的学习的有效交流。我们定义了慢性病护理管理和综合护理，然后总结了当前的理论和证据。我们描述了国家政策的发展（自2000年以来与综合护理相关），包括《新西兰卫生战略》、《新西兰初级保健战略》、初级卫生组织（PHOs）的发展、按人头付费、“关爱有加”以及改善就医机会服务资金。然后我们描述了曼努考郡的慢性病护理管理，它在国际上理论和证据的完善以及国家政策的制定和实施之前及期间都有所发展。我们借助对英国的比较反思，思考了当地迄今为止的进展以及未来改进的机会（和障碍）。我们最重要的信息如下：给政策制定者和资助者——新西兰卫生系统正在发生向团队合作的脆弱文化转变；这种转变需要得到具体而积极的支持。给初级卫生组织——一般诊疗需要帮助来使其内部（诊疗内部）财务信号与按人头付费和综合护理的新世界保持一致。给初级和二级护理医生、护士及其他护理人员——系统的慢性病护理管理和综合护理可以提高患者的生活质量；并且如果医疗保健结构和系统得到妥善管理以支持整合，那么医疗保健提供者的职业和个人满意度将会提高。
