Chuang Elizabeth, Ganti Valli, Alvi Afshan, Yandrapu Harathi, Dalal Mehul
Montefiore Medical Center, Bronx, NY, USA.
J Prim Care Community Health. 2014 Jan 1;5(1):61-6. doi: 10.1177/2150131913516497. Epub 2013 Dec 18.
Panel management is a system of care that targets groups of patients with similar needs to improve their quality of care. The purpose of this pilot was to determine whether panel management could improve blood pressure control in patients with previously uncontrolled hypertension and to explore how panel management can be integrated in an urban, low-income, primary care setting.
The practice coach model was used to assist a clinical site in forming a quality improvement team to implement panel management. The team created a patient registry to track hypertensive patients over time and to recall patients with uncontrolled hypertension for planned care visits during which evidence-based interventions for hypertension were delivered. Percent of patients gaining control of blood pressure and change in blood pressure were measured between 6 and 9 months after enrollment. Qualitative interviews of clinic staff were completed to explore strengths and weaknesses of program implementation.
Forty patients with uncontrolled hypertension were enrolled in the pilot, and 27.5% gained blood pressure control by 9 months after enrollment (P < .001). The average systolic blood pressure decreased by 16 mm Hg from 156.5 to 140.5 mm Hg (P < .001), and the average diastolic blood pressure decreased by 3.8 mm Hg from 85 to 81.2 mm Hg (P = .03). Staff interviews were generally positive; however, several areas for improvement were identified.
Panel management for hypertension can be effective and can be implemented in a low-income, urban, primary care clinic setting given appropriate staffing allocation.
小组管理是一种针对有相似需求患者群体的护理系统，旨在提高其护理质量。本试点研究的目的是确定小组管理能否改善既往血压控制不佳的高血压患者的血压控制情况，并探索如何在城市低收入基层医疗环境中整合小组管理。
采用实践指导模式协助一个临床站点组建质量改进团队以实施小组管理。该团队创建了一个患者登记册，用于长期跟踪高血压患者，并召回血压控制不佳的患者进行计划中的护理就诊，在此期间提供基于证据的高血压干预措施。在入组后6至9个月测量血压得到控制的患者百分比以及血压变化情况。完成了对诊所工作人员的定性访谈，以探讨项目实施的优点和缺点。
40例血压控制不佳的高血压患者参与了该试点研究，入组后9个月时27.5%的患者血压得到控制（P <.001）。平均收缩压从156.5毫米汞柱降至140.5毫米汞柱，下降了16毫米汞柱（P <.001），平均舒张压从85毫米汞柱降至81.2毫米汞柱，下降了3.8毫米汞柱（P =.03）。工作人员访谈总体上是积极的；然而，也确定了几个需要改进的方面。
在给予适当人员配置的情况下，高血压小组管理是有效的，并且可以在城市低收入基层医疗诊所环境中实施。
