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慢性病护理模式的概念化:对家庭护理个案管理实践的启示。

Conceptualization of the Chronic Care Model: Implications for Home Care Case Manager Practice.

作者信息

Garland-Baird Lisa, Fraser Kimberly

机构信息

Lisa Garland-Baird, RN, MN, is a Faculty of Nursing, University of Alberta, Edmonton, Alberta. Kimberly Fraser, PhD, is an Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta.

出版信息

Home Healthc Now. 2018 Nov/Dec;36(6):379-385. doi: 10.1097/NHH.0000000000000699.

Abstract

One of the greatest challenges for healthcare systems is the management and prevention of chronic diseases. Wagner's Chronic Care Model aims to transform the daily care of patients with chronic illnesses from acute and reactive to proactive, planned, and population-based. The purpose of this article is to provide a review of the available research relating to the Chronic Care Model and consider the implications for Home Care Case Management practice. A total of 18 research studies (5 qualitative and 13 quantitative) were reviewed. A thematic content analysis approach was used. The findings included three themes: Chronic Care Model and positive chronic illness health behaviors and outcomes; Chronic Care Model and delivery of quality chronic illness care; and the importance of the supportive role of the home care nurse in the role of Home Care Case Management. Gaps and limitations of the Chronic Care Model in relation to Home Care Case Management were identified and discussed in relationship to partnership building and reciprocal trust between patients, family caregivers, and the Home Care Case Manager. Finally, implications for the use of the Chronic Care Model in Home Care Case Manager practice, policy development, and future research were presented.

摘要

医疗保健系统面临的最大挑战之一是慢性病的管理和预防。瓦格纳的慢性病护理模式旨在将慢性病患者的日常护理从急性和反应性转变为主动、有计划且基于人群的护理。本文的目的是对与慢性病护理模式相关的现有研究进行综述,并探讨其对家庭护理个案管理实践的影响。共综述了18项研究(5项定性研究和13项定量研究)。采用了主题内容分析方法。研究结果包括三个主题:慢性病护理模式与积极的慢性病健康行为及结果;慢性病护理模式与优质慢性病护理的提供;以及家庭护理护士在家庭护理个案管理中的支持作用的重要性。确定并讨论了慢性病护理模式在家庭护理个案管理方面的差距和局限性,并涉及患者、家庭护理人员和家庭护理个案管理员之间的伙伴关系建立和相互信任。最后,阐述了慢性病护理模式在家庭护理个案管理实践、政策制定和未来研究中的应用意义。

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