William H. Dietz (
Loel S. Solomon is vice president of community health at Kaiser Permanente, in Oakland, California.
Health Aff (Millwood). 2015 Sep;34(9):1456-63. doi: 10.1377/hlthaff.2015.0371.
Improved patient experience, population health, and reduced cost of care for patients with obesity and other chronic diseases will not be achieved by clinical interventions alone. We offer here a new iteration of the Chronic Care Model that integrates clinical and community systems to address chronic diseases. Obesity contributes substantially to cardiovascular disease, type 2 diabetes mellitus, and cancer. Dietary and physical activity interventions will prevent, mitigate, and treat obesity and its related diseases. Challenges with the implementation of this model include provider training, the need to provide incentives for health systems to move beyond clinical care to link with community systems, and addressing the multiple elements necessary for integration within clinical care and with social systems. The Affordable Care Act, with its emphasis on prevention and new systems for care delivery, provides support for innovative strategies such as those proposed here.
改善肥胖症和其他慢性病患者的就医体验、增进人群健康并降低其医疗成本,仅靠临床干预是无法实现的。我们在此提出慢性疾病照护模式的一个新迭代版本,旨在整合临床和社区系统以应对慢性疾病。肥胖症是心血管疾病、2 型糖尿病和癌症的重要致病因素。饮食和身体活动干预措施可预防、减轻和治疗肥胖症及其相关疾病。该模式实施所面临的挑战包括对医务人员的培训、需要激励卫生系统将工作重点从临床护理转移到与社区系统的联系、以及解决在临床护理和社会系统中实现整合所必需的多个要素。《平价医疗法案》强调预防和新的医疗服务提供系统,为这里提出的创新性策略提供了支持。