Coleman Karen J, Hemmila Tani, Valenti Mark D, Smith Nasya, Quarrell Rachel, Ruona Lynnice K, Brandenfels Emily, Hann Barbara, Hinnenkamp Todd, Parra Margarita D, Monkman Jeyn, Vos Sue, Rossom Rebecca C
Department of Research and Evaluation, Kaiser Permanente Southern California (KPSC), 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA 91101-2453, USA.
Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA.
Gen Hosp Psychiatry. 2017 Jan-Feb;44:86-90. doi: 10.1016/j.genhosppsych.2016.03.003. Epub 2016 Aug 22.
OBJECTIVE: To understand how care managers implemented COMPASS and if this was related to patient health outcomes. METHODS: A total of 96 COMPASS care managers were approached to participate in the online survey and 93 (97%) provided responses. Correlations were generated between key survey responses and the average number of care management contacts, patient depression, blood pressure and glycosylated hemoglobin outcomes. RESULTS: Patients of care managers who reported spending more time on COMPASS-related tasks had higher rates of depression improvement (r=0.34; P=.002) and remission (r=0.27; P=.02) as well as higher rates of blood pressure control (r=0.29; P=.03). CONCLUSIONS: To improve the effectiveness of care management in collaborative care models, particularly for patients with comorbid conditions and complex nonmedical needs, care managers need the support of social work and administrative support staff. Care managers for this patient population would also benefit from more intensive training in nonpharmacological depression treatment, such as motivational interviewing and behavioral activation. Additionally, systems support is needed such as education for primary care teams and psychiatry on the value of collaborative care models and integration of population management tools into electronic medical records.
目的:了解护理经理如何实施COMPASS,以及这是否与患者健康结果相关。 方法:共邀请96名COMPASS护理经理参与在线调查,93名(97%)提供了回复。对关键调查回复与护理管理联系的平均次数、患者抑郁、血压和糖化血红蛋白结果之间进行相关性分析。 结果:报告在COMPASS相关任务上花费更多时间的护理经理的患者,抑郁改善率更高(r = 0.34;P = 0.002),缓解率更高(r = 0.27;P = 0.02),血压控制率也更高(r = 0.29;P = 0.03)。 结论:为提高协作护理模式中护理管理的有效性,特别是对于患有合并症和复杂非医疗需求的患者,护理经理需要社会工作和行政支持人员的支持。针对这类患者群体的护理经理也将从非药物抑郁治疗方面更深入的培训中受益,如动机性访谈和行为激活。此外,还需要系统支持,如对初级保健团队和精神病学进行关于协作护理模式价值以及将人群管理工具整合到电子病历中的教育。
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