School of Nursing, Sun Yat-sen University, Guangzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Int J Nurs Pract. 2022 Dec;28(6):e13104. doi: 10.1111/ijn.13104. Epub 2022 Sep 6.
Case management has been regarded as the front line of necessary change for fragmented healthcare system.
This study proposed a case management intervention that is suitable for Chinese colorectal cancer patients and explored its effectiveness over a 12-month follow-up.
A quasi-experimental study was conducted in an oncology hospital in China. A total of 188 patients were recruited from May 2015 to February 2017; 85 patients in the control group and 80 patients in the intervention group were included in data analysis. The intervention group was managed for 1 year by a case manager who organized the multidisciplinary team, provided regular assessment, a consulting service and referrals. Quality of life, anxiety and depression, symptom distress, treatment adherence and unplanned readmission rates were measured.
Repeated measurement ANOVA showed significant intervention and time effects in global quality of life, anxiety and depression, symptom distress and oral chemotherapy adherence. The intervention group showed statistically significantly better overall treatment adherence and lower unplanned readmission rate.
Nurse-led case management was effective in improving psychosocial outcomes, treatment adherence and unplanned readmission rate of colorectal cancer patients. A case management model is feasible and effective in colorectal cancer patients and in hospital-dominated healthcare systems where primary care is underutilized.
病例管理被视为碎片化医疗体系必要变革的前沿。
本研究提出了一种适合中国结直肠癌患者的病例管理干预措施，并探讨了其在 12 个月随访中的效果。
在中国的一家肿瘤医院进行了一项准实验研究。2015 年 5 月至 2017 年 2 月期间共招募了 188 名患者，其中 85 名患者在对照组，80 名患者在干预组纳入数据分析。干预组由一名病例经理管理 1 年，病例经理组织多学科团队，提供定期评估、咨询服务和转诊。测量生活质量、焦虑和抑郁、症状困扰、治疗依从性和非计划性再入院率。
重复测量方差分析显示，在总体生活质量、焦虑和抑郁、症状困扰和口服化疗依从性方面，干预和时间均有显著效果。干预组在整体治疗依从性方面表现出统计学上的显著改善，非计划性再入院率较低。
护士主导的病例管理在改善结直肠癌患者的心理社会结局、治疗依从性和非计划性再入院率方面是有效的。病例管理模式在以医院为中心、初级保健利用不足的医疗体系中对结直肠癌患者是可行且有效的。
