门诊多病症患者：以患者为中心和需求导向的医疗保健管理（MamBo）-多视角评估研究方案。

People with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management (MamBo) - protocol for a multiperspective evaluation study.

机构信息

Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany.

Professional association of ophthalmologists in Germany e.V, Düsseldorf, Germany.

出版信息

BMC Health Serv Res. 2020 Apr 13;20(1):296. doi: 10.1186/s12913-020-05178-6.

DOI:10.1186/s12913-020-05178-6

PMID:32284047

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7153233/

Abstract

BACKGROUND

With demographic change, the number of noncommunicable diseases, chronic diseases and multimorbidity is increasing, and so is the demand for health services. This represents a further challenge for the healthcare system. An adequate and efficient treatment of multimorbid patients requires a well-structured, informed and cross-indicated treatment. Therefore, a new form of coordinated, managed and cross-sectoral care for multimorbid patients - the "MamBo" care model - has been developed. Along with the implementation of MamBo, a process and outcome evaluation will be carried out, which is described in this study protocol. The aim of the study is to evaluate the care model according to its implementation process and effectiveness.

METHODS

The MamBo-care model will be evaluated in multi-perspective terms. Thus, a process and outcome evaluation with several data sources will be conducted: (1) Annual focus groups and individual interviews with those involved in the process. (2) Various primary data, including surveys of patients, physicians and practice staff at the time of enrolment and 1 year later to enable pre-post comparison. (3) Claim data from the health insurance of the MamBo population in comparison to a comparative population, formed by the propensity score matching method. (4) Process data of the care management. The analysis of qualitative data will be carried out by content analysis according to Mayring. For the analysis of the quantitative data, multivariate analyses are planned.

DISCUSSION

A new form of coordinated care has been introduced to improve intersectoral care of multimorbid patients and reduce the workload on physicians. The effects of the MamBo care model are being investigated for patients, physicians and the cost units. The results will form the basis for the decision whether the care model should be transferred to standard care and what needs to be taken into account for implementation.

TRIAL REGISTRATION

The study was retrospectively registered in the German Register for Clinical Studies (DRKS00014047) on June 28, 2019.

摘要

背景

随着人口结构的变化，非传染性疾病、慢性病和多种疾病的数量不断增加，对卫生服务的需求也在增加。这对医疗保健系统构成了进一步的挑战。为了充分有效地治疗多种疾病患者，需要对其进行结构化、知情和跨学科的治疗。因此，针对多种疾病患者，开发了一种新的协调、管理和跨部门的护理模式，即“MamBo”护理模式。随着 MamBo 的实施，将进行过程和结果评估，本研究方案对此进行了描述。本研究的目的是根据实施过程和效果评估该护理模式。

方法

MamBo 护理模式将从多方面进行评估。因此，将通过多种数据源进行过程和结果评估：（1）每年对参与该过程的人员进行焦点小组和个人访谈。（2）各种原始数据，包括患者、医生和实践工作人员在入组时和 1 年后的调查，以便进行前后比较。（3）与比较人群（通过倾向评分匹配方法形成）相比，从 MamBo 人群的健康保险中获取索赔数据。（4）护理管理的过程数据。定性数据分析将根据 Mayring 进行内容分析。对于定量数据分析，计划进行多变量分析。