Koontalay Apinya, Botti Mari, Hutchinson Anastasia
School of Nursing and Midwifery, Deakin University, Victoria, Australia.
Center for Quality and Patient Safety Research - Epworth HealthCare Partnership, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
Health Expect. 2025 Feb;28(1):e70142. doi: 10.1111/hex.70142.
Health service leaders in Thailand face substantial challenges in addressing the needs of a growing population of patients with moderate to severe Chronic Heart Failure (CHF) who require acute care management and ongoing supportive care in the community. The large number of CHF patients requiring readmission for high-level care places a significant burden on healthcare services.
The design thinking model proposed by the Hasso-Plattner Institute of Design at Stanford University underpinned an approach to developing a co-designed, tailored, culturally acceptable model of chronic care for people with CHF. One consumer, 16 clinicians, and two organisational leaders participated in a codesign workshop that included three activities. The purpose of each activity was to (i) define the problem, (ii) brainstorm possible solutions and (iii) develop a prototype solution. The codesign workshop was one phase of a four-phase codesign project. Data collected included physical data such as sticky notes and storyboards and audio recordings of codesign group discussions. Data were analyses using content analysis.
Nine prototype storyboards aimed at enhancing continuity of care for CHF patients emerged from the workshop activities. The proposed solutions focused on improving consumer access to evidence-based information, multidisciplinary expertise and ongoing community support. Participants discussed and evaluated the viability and feasibility of each prototype before reaching a final decision on an optimal model. The preferred model was a nurse-led case management service supported by a multidisciplinary team.
Key stakeholders identified the importance of moving from a short-term model of care to an integrated, multidisciplinary approach to providing long-term support in the community. The final agreed prototype of a CHF Nurse Case Management service supported by a multidisciplinary team with a focus on community outreach addressed the key concerns of participants and was considered a feasible approach to developing a CHF chronic care service for the community in urban Bangkok, Thailand.
The process of codesign involved the engagement and participation of individuals with CHF, clinicians and organisational leaders throughout the research process.
泰国的医疗服务领导者在满足日益增长的中重度慢性心力衰竭（CHF）患者群体的需求上面临重大挑战，这些患者需要急性护理管理以及社区的持续支持性护理。大量需要再次入院接受高级护理的CHF患者给医疗服务带来了巨大负担。
斯坦福大学哈索·普拉特纳设计学院提出的设计思维模型为开发一种共同设计、量身定制、文化上可接受的CHF患者慢性护理模型提供了一种方法。一名患者、16名临床医生和两名组织领导者参加了一个包括三项活动的共同设计研讨会。每项活动的目的是：（i）定义问题，（ii）集思广益可能的解决方案，以及（iii）开发一个原型解决方案。该共同设计研讨会是一个四阶段共同设计项目的一个阶段。收集的数据包括便利贴和故事板等实物数据以及共同设计小组讨论的录音。使用内容分析法对数据进行分析。
研讨会上的活动产生了九个旨在增强CHF患者护理连续性的原型故事板。提出的解决方案侧重于改善患者获取循证信息、多学科专业知识和持续社区支持的机会。在就最佳模型做出最终决定之前，参与者讨论并评估了每个原型的可行性。首选模型是由多学科团队支持的护士主导的病例管理服务。
关键利益相关者认识到从短期护理模式转向综合、多学科方法以在社区提供长期支持的重要性。由多学科团队支持、以社区外展为重点的CHF护士病例管理服务的最终商定原型解决了参与者的关键问题，并被认为是为泰国曼谷市区社区开发CHF慢性护理服务的可行方法。
共同设计过程涉及CHF患者、临床医生和组织领导者在整个研究过程中的参与。
