Bleich Sara N, Sherrod Cheryl, Chiang Anne, Boyd Cynthia, Wolff Jennifer, DuGoff Eva, Salzberg Claudia, Anderson Keely, Leff Bruce, Anderson Gerard
The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Prev Chronic Dis. 2015 Nov 12;12:E197. doi: 10.5888/pcd12.150275.
Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population.
We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated.
Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care - care and case management and disease management - reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes.
Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.
找到为患有多种慢性病或残疾的人群提供更好且成本更低的医疗保健方法是一个紧迫的问题。本系统评价的目的是评估照顾这一高需求和高成本人群的不同方法。
我们检索了Medline中2008年5月31日至2014年6月10日发表的相关研究文章。如果文章符合以下标准，则被认为符合本评价的条件：纳入患有多种慢性病（行为或心理健康方面）或残疾（两种或更多）的人群；涉及一个或多个临床结局、医疗保健使用和支出或患者满意度；并将干预组的结果与对照组或基线测量结果进行比较。我们提取了有关项目特征、参与者特征以及显著（正面和负面）临床发现、患者满意度和医疗保健使用结果的信息。对于每个结局，将显著和正面结果的数量制成表格。
纳入了涵盖5种护理模式的27项研究。在报告患者满意度结局的3项研究中，2项报告有显著改善；两者均为随机对照试验（RCT）。在报告临床结局的14项研究中，12项报告有改善（8项为RCT）。在报告医疗保健使用和支出结局的13项研究中，12项报告有显著改善（2项为RCT）。两种护理模式——护理与病例管理以及疾病管理——在所有3个结局方面均报告有改善。对于护理与病例管理模式，大多数改善与医疗保健使用有关。对于疾病管理模式，大多数改善与临床结局有关。
护理与病例管理以及疾病管理可能是照顾患有多种慢性病或残疾人群的有前景的护理模式。需要更多研究和一致的方法来了解针对这些高需求和高成本患者的最合适护理。
