Morales-Asencio José Miguel
Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, España.
Enferm Clin. 2014 Jan-Feb;24(1):23-34. doi: 10.1016/j.enfcli.2013.10.002. Epub 2013 Dec 5.
Chronic diseases are the greatest challenge for Health Care, but the conventional health care models have failed noticeably. Nurses are one of the main providers of the services developed to tackle this challenge, with special emphasis on case management, as one of the most common forms. But, one of the key problems is that case management is poorly conceptualized, and with the diversity of experience available, make its development and comparative evaluation difficult. An in-depth review on case management definition and concepts is presented in this article, with a description of the models, ingredients and the effectiveness reported in various studies. The remaining uncertainties in case management, such as the heterogeneity of designs and target populations, the weak description of the components, and the scarce use of research models for complex interventions, are also discussed. Finally, some key factors for a successful implementation of case management are detailed, such as a clear definition of accountability and roles, the existence of support to guarantee the competence of case managers, the use of valid mechanisms for case finding, adjusted caseload, accessible and team-shared record systems, or the integration of health and social services.
慢性病是医疗保健面临的最大挑战，但传统的医疗保健模式已明显失败。护士是为应对这一挑战而开展的服务的主要提供者之一，尤其强调病例管理，这是最常见的形式之一。但是，关键问题之一是病例管理的概念化不足，而且由于经验多样，使得其发展和比较评估变得困难。本文对病例管理的定义和概念进行了深入回顾，描述了各种研究中报告的模式、要素和有效性。还讨论了病例管理中仍然存在的不确定性，例如设计和目标人群的异质性、组成部分描述薄弱以及复杂干预研究模型的使用不足。最后，详细阐述了成功实施病例管理的一些关键因素，例如明确界定问责制和角色、存在支持以确保病例管理人员的能力、使用有效的病例发现机制、调整工作量、可访问且团队共享的记录系统，或整合卫生和社会服务。
