摘要
目的 观察新模式下的管理组在军人慢病管理中的效果。方法 将本院2017年1月入院的6种慢性疾病患者126人,采用随机数字表法,按入院顺序随机分成2组,分别为研究组和对照组,对照组采用常规护理、健康教育、出院后定期随访,电话答疑;研究组采用新模式下的管理,并对其进行全程管理。“新模式下的管理”,即将“医护合体”诊疗模式和“医院-社区-家庭一体化”慢病管理模式相结合,对涉及慢病的科室,由科主任、护长、医师、护士、心理咨询师、营养师、卫生员、家属构成的管理组。通过定期评估健康教育需求、共享健康档案及医院定期对卫生员专科培训、多向沟通渠道、培养“资深级患者”等方式多维度做好慢病管理。1年后,比较两组患者出院指导质量量表评分及慢性病自我管理行为量表评分,评价管理效果。结果 研究组两者得分显著高于对照组(P<0.01)。结论 新模式下的管理组能提高慢病出院指导质量及患者自我管理行为,在军人慢病管理中发挥积极的作用。
Objective To observe the effect of the new management group in the management of chronic disease of soldiers.Methods 126 patients with six chronic diseases admitted to our hospital in January 2017 were randomly divided into two groups according to the order of admission,the study group and the control group.The control group was given routine nursing,health education,regular follow-up after discharge,and answering questions by telephone.The study group was managed by the management group under the new mode.Under the new model,the management group was composed of department directors,head nurses,doctors,nurses,psychological consultants,nutritionists,health workers and family members.Chronic diseases were managed through multi-dimensional ways such as regular assessment of health education needs,sharing health records and regular hospital training for health workers,multi-directional communication channels,training“senior patients”,etc.One year later,the quality of discharge guidance scale and chronic disease self-management behavior scale were compared between the two groups to evaluate the management effect.Results The scores of the two groups were significantly higher than those of the control group(P<0.01).Conclusion The new mode of chronic disease management group can improve the quality of discharge guidance and patient self-management behavior of chronic diseases,and plays an active role in the management of chronic diseases in soldiers.
作者
袁丽
张燕凌
冯青峰
淮瑾
席亚莉
YUAN Li;ZHANG Yanling;FENG Qingfeng;HUAI Jin;XI Yali(Department of Endocrinology and Hematology,No.1 Hospital of PLA,Lanzhou 730030;No.1 Hospital of PLA,Lanzhou 730030)
出处
《解放军医院管理杂志》
2019年第1期36-41,共6页
Hospital Administration Journal of Chinese People's Liberation Army
关键词
医护合体
医院-社区-家庭一体化
慢性疾病
管理
medical treatment and nursing synthesis
hospital-community-family integration
chronic disease
management
