Carswell Peter
School of Population Health, University of Auckland, Auckland, New Zealand.
Int J Integr Care. 2015 Sep 23;15:e014. doi: 10.5334/ijic.2242. eCollection 2015 Apr-Jun.
Te Whiringa Ora is a community-based programme in New Zealand that facilitates interdisciplinary care for patients and their family. It targets those with a chronic disease whom have high inpatient admissions or emergency department presentations. It is based in a rural part of New Zealand that has a large indigenous population, and a relatively high level of social deprivation. The programme makes use of culturally appropriate care coordinators, and uses telephone support and tele-monitoring to aid self-management. The programme has been running for three years and has shown a reduction on hospital presentations, as compared to an equivalent population (not enrolled in the programme). This case study outlines the programme, and focuses specifically on the implementation processes, and lessons learnt.
“Te Whiringa Ora”是新西兰一项基于社区的项目，该项目为患者及其家人提供跨学科护理。其目标人群是那些住院次数多或频繁前往急诊科就诊的慢性病患者。该项目位于新西兰农村地区，当地有大量原住民，且社会贫困程度相对较高。该项目利用了文化上合适的护理协调员，并通过电话支持和远程监测来帮助自我管理。该项目已运行三年，与同等人群（未参加该项目）相比，已显示出医院就诊次数有所减少。本案例研究概述了该项目，并特别关注其实施过程和经验教训。
