Hudon Catherine, Chouinard Maud-Christine, Bisson Mathieu, Brousselle Astrid, Lambert Mireille, Danish Alya, Rodriguez Charo, Sabourin Véronique
Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada.
Centre de recherche du CHUS, 12e Avenue Nord Porte 6, Sherbrooke, QC, Canada.
Int J Integr Care. 2022 Feb 11;22(1):11. doi: 10.5334/ijic.5652. eCollection 2022 Jan-Mar.
Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use.
A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada).
Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers' access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integrated care and healthcare services use.
This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.
针对有复杂医疗需求的医疗服务频繁使用者的病例管理项目（CMP），是改善患者综合护理体验、减少医疗服务过度使用和成本的有效策略。本研究旨在确定这些项目的特征及其实施背景，以帮助改善患者自我管理、综合护理体验和医疗服务使用情况。
采用混合方法多重嵌入式案例研究设计，在加拿大魁北克一个地区的六家医院实施了六个病例管理项目。
案例内分析描述了每个病例管理项目的结构、环境、组织、从业者、患者和创新层面的特征，以及基于患者体验、自我管理和医疗服务使用情况的服务整合结果。跨案例分析表明，病例管理者的技能、领导力和经验、提供者获取个性化服务计划的机会、对患者及其家庭成员需求的考虑、他们参与决策的情况以及自我管理方法，会影响综合护理和医疗服务的使用。
本研究强调，需要有一位经验丰富、知识渊博且训练有素、具备人际沟通技巧的病例管理者，以优化病例管理项目的实施，从而使患者在护理中更加积极主动，并改善其治疗效果。
