Johnson Paisley, Raterink Ginger
Cardiovascular Institute of San Diego, Chula Vista, CA, USA.
J Clin Nurs. 2009 Jul;18(14):2096-103. doi: 10.1111/j.1365-2702.2008.02774.x.
The American Association of Diabetic Educators suggests that educating patients about their diabetes management facilitates problem solving and coping skills. This paper will describe a clinic-in-a-clinic model of care delivery founded on the principles of the Chronic Care Model and focused towards the outcomes proposed by the American Association of Diabetic Educators. The reader will be introduced to the use of the 'plan, do, study, act' process used to develop this model in a clinical setting.
Self-management support, a key component of the Chronic Care Model, focuses on providing patients with the skills to make healthcare decisions. Self-management encourages patient to be responsible for his/her own health care. Because diabetes outcomes and complication prevalence are related to the degree of self involvement in illness care, self-management support is an important component of disease management.
Plan, do, study, act model for program development.
The 'plan, do, study, act' cycles outlined the steps needed to implement the clinic-in-a-clinic program with success related to coordination of all components and continual assessment and revision. Each cycle was initiated in a sequential order allowing for evaluation and goal adjustment before the next cycle was implemented.
The majority of patients seen were middle-aged, obese, females with HbA1cs greatly above the recommended 7.0. Patients selected a variety of topics related to diabetes management for their clinical session. Participation rates were consistent with regular clinic visit attendance. Barriers to success of the program were related to both structure and process.
The clinic-in-a-clinic design moves disease management from individual practice into a property of the health systems and places importance on the collaboration of patient, provider and delivery system in reducing the consequences of chronic illness. Use of the 'plan, do, study, act' cycle model offers a method for changing the process of care delivery in a structured, sequential approach.
美国糖尿病教育者协会指出，对患者进行糖尿病管理教育有助于培养问题解决能力和应对技巧。本文将描述一种基于慢性病护理模式原则并以美国糖尿病教育者协会提出的结果为导向的“诊所内诊所”护理模式。读者将了解在临床环境中用于开发此模式的“计划、执行、研究、行动”流程。
自我管理支持是慢性病护理模式的关键组成部分，专注于为患者提供做出医疗保健决策的技能。自我管理鼓励患者对自己的医疗保健负责。由于糖尿病结果和并发症患病率与患者自身参与疾病护理的程度相关，因此自我管理支持是疾病管理的重要组成部分。
用于项目开发的计划、执行、研究、行动模式。
“计划、执行、研究、行动”循环概述了成功实施“诊所内诊所”项目所需的步骤，这与所有组件的协调以及持续评估和修订有关。每个循环按顺序启动，以便在下一个循环实施之前进行评估和目标调整。
大多数就诊患者为中年肥胖女性，糖化血红蛋白水平远高于推荐的7.0。患者在临床课程中选择了各种与糖尿病管理相关的主题。参与率与定期门诊就诊率一致。该项目成功的障碍与结构和流程都有关。
“诊所内诊所”设计将疾病管理从个体实践转变为卫生系统的一项属性，并强调患者、提供者和服务提供系统在减少慢性病后果方面的协作。使用“计划、执行、研究、行动”循环模型提供了一种以结构化、顺序化方式改变护理提供过程的方法。
