Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115 Heidelberg, Germany.
Implement Sci. 2010 Sep 21;5:70. doi: 10.1186/1748-5908-5-70.
Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based complex care management program for chronically ill patients at high risk for future hospitalization in Germany.
We present a multi-method procedure to develop a complex care management program to implement interventions aimed at reducing potentially avoidable hospitalizations for primary care patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, or chronic heart failure and a high likelihood of hospitalization. The procedure will start with reflection about underlying precipitating factors of hospitalizations and how they may be targeted by the planned intervention (pre-clinical phase). An intervention model will then be developed (phase I) based on theory, literature, and exploratory studies (phase II). Exploratory studies are planned that entail the recruitment of 200 patients from 10 general practices. Eligible patients will be identified using two ways of 'case finding': software based predictive modelling and physicians' proposal of patients based on clinical experience. The resulting subpopulations will be compared regarding healthcare utilization, care needs and resources using insurance claims data, a patient survey, and chart review. Qualitative studies with healthcare professionals and patients will be undertaken to identify potential barriers and enablers for optimal performance of the complex care management program.
This multi-method procedure will support the development of a primary care-based care management program enabling the implementation of interventions that will potentially reduce avoidable hospitalizations.
复杂护理管理被视为一种应对老龄化社会挑战的方法，该社会中患者数量不断增加，且对复杂护理的需求也在不断增加。英国医学研究委员会提出了一个用于开发和评估复杂干预措施的框架，该框架将用于开发和评估德国针对高风险未来住院的慢性病患者的基于初级保健的复杂护理管理计划。
我们提出了一种多方法程序，以开发一种复杂的护理管理计划，以实施旨在减少 2 型糖尿病、慢性阻塞性肺疾病或慢性心力衰竭患者和高住院可能性的初级保健患者潜在可避免住院的干预措施。该程序将首先考虑住院的潜在促成因素以及计划干预措施如何针对这些因素（临床前阶段）。然后，将基于理论、文献和探索性研究（第二阶段）开发干预模型（第一阶段）。计划进行探索性研究，从 10 家普通诊所招募 200 名患者。将使用两种“病例发现”方法识别符合条件的患者：基于软件的预测建模和医生根据临床经验提出的患者。将使用保险索赔数据、患者调查和图表审查，对由此产生的亚人群进行医疗保健利用、护理需求和资源方面的比较。将进行与医疗保健专业人员和患者的定性研究，以确定复杂护理管理计划最佳实施的潜在障碍和促成因素。
该多方法程序将支持基于初级保健的护理管理计划的开发，从而能够实施潜在减少可避免住院的干预措施。
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