台湾某单一医疗中心癌症患者的护士病例管理与常规护理的效果比较：一项准实验研究。
Effectiveness of nurse case management compared with usual care in cancer patients at a single medical center in Taiwan: a quasi-experimental study.
机构信息
Taipei Veterans General Hospital, Taipei, Taiwan.
出版信息
BMC Health Serv Res. 2013 May 31;13:202. doi: 10.1186/1472-6963-13-202.
BACKGROUND
In order to improve treatment and care quality for cancer patients, nurse case management model has applied generally in the clinical practice. However there were only few evidence-based studies on the relative benefits in Taiwan. Further analysis and feedback application are needed. The aim of this study is to evaluate the effectiveness of care quality in cancer patients with nurse case management.
METHODS
This study was conducted with a quasi-experimental design in a national medical center in Northern Taiwan. Patients diagnosed as lung, liver, breast, colon, buccal or cervical cancers were eligible for inclusion. A total number of 600 subjects randomly selected from the cancer case management system enrolled in the case managed group, and 600 patients who received usual care were randomly selected from cancer registry and enrolled in the control group. The study instrument was developed to measure care effectiveness, including the rates of patient continuing treatment, non-adherence to treatment, prolonged hospitalization, unplanned readmission, and planned admission for active treatment. The content validity of expert was assessed as 0.9.
RESULTS
The nurse case management significantly decreased the unplanned readmission rate caused by infection (1.5% vs. 4.7% in the control group, p = 0.002). The rate of patient continuing treatment in the institution significantly increased in the case managed group (93.8% vs. 84.8% in the control group, p < 0.001). The planned admission rates in 14 days and in 15-30 days for active treatment also significantly increased in the case managed group (18.4.% vs. 3.9% in the control group and 34.5% vs. 10.4% in the control group, respectively, p < 0.001). The results indicated that nurse case management provided better control in timeliness and continuity of patient treatment.
CONCLUSIONS
This study demonstrated that cancer case management could improve the effectiveness of cancer care services and concretely illustrated a comprehensive model for oncology patients in Taiwan. In addition, the model could be optimized for further application and improvement of cancer care. Future investigations are needed to develop precise and rigorous evaluation to optimize the utilization of cancer case management.
背景
为了提高癌症患者的治疗和护理质量，护士病例管理模式已在临床实践中得到广泛应用。然而，在台湾，仅有少量基于证据的研究证明了该模式的相对益处。需要进一步分析和反馈应用。本研究旨在评估护士病例管理对癌症患者护理质量的效果。
方法
本研究采用准实验设计，在台湾北部的一家国立医学中心进行。纳入的患者被诊断为肺癌、肝癌、乳腺癌、结肠癌、口腔癌或宫颈癌。从癌症病例管理系统中随机抽取 600 名符合条件的患者纳入病例管理组，从癌症登记处随机抽取 600 名接受常规护理的患者纳入对照组。研究工具用于测量护理效果，包括患者继续治疗的比率、治疗不依从率、住院时间延长、非计划性再入院率和计划入院进行积极治疗的比率。专家内容效度评估为 0.9。
结果
护士病例管理显著降低了因感染导致的非计划性再入院率（对照组为 4.7%，病例管理组为 1.5%，p = 0.002）。在机构内继续治疗的患者比例在病例管理组显著增加（对照组为 84.8%，病例管理组为 93.8%，p < 0.001）。在 14 天和 15-30 天内计划入院进行积极治疗的比例也在病例管理组显著增加（对照组分别为 3.9%和 10.4%，病例管理组分别为 18.4.%和 34.5%，p < 0.001）。结果表明，护士病例管理提供了更好的治疗及时性和连续性控制。
结论
本研究表明，癌症病例管理可以提高癌症护理服务的效果，并具体说明了台湾癌症患者的综合管理模式。此外，该模式可以进行优化，进一步应用于癌症护理的改进。未来的研究需要制定精确和严格的评估，以优化癌症病例管理的利用。
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