个案管理模式的应用现状与启示

doi:10.3761/j.issn.1672-9234.2021.01.019

摘要/Abstract

摘要：

个案管理作为一种管理模式,在规范医院管理、优化医疗管理服务流程、患者管理、整合社区资源、疾病管理、延续护理服务等方面能够发挥重要作用,实现了在医疗、患者、护理上的三赢。该文阐述了个案管理的概念、运作程序、个案管理在慢性病管理中的应用,以及与临床路径、诊断相关分组的有机结合等内容,以期为个案管理工作的开展提供参考。

关键词: 病例管理, 慢性病, 临床路径, 综述

Abstract:

As a management model,case management model can play an important role in standardizing hospital management,optimizing medical service processes and patient management,integrating community resources,managing diseases,and providing continuous nursing services. The model can contribute to the “win-win” situations among physicians,nurses,and patients. This paper elaborated the concept of case management,operating procedures,the effects of case management in chronic disease management,and the combination of clinical pathways and diagnosis-related groupings. Hopefully,we can provide references for the development of case management.

Key words: Case Management, Chronic Disease, Critical Pathways, Review

杨桂华, 袁玮, 梁亚慧, 常宗霞. 个案管理模式的应用现状与启示[J]. 中华护理教育, 2021, 18(1): 92-96.

YANG Gui-hua, YUAN Wei, LIANG Ya-hui, CHANG Zong-xia. The current status of case management model application and its implications to the practice[J]. Chinese Journal of Nursing Education, 2021, 18(1): 92-96.

参考文献 37

[1]	Matthews P . Case management information systems:how to put the pieces together now and beyond year 2000[J]. Nurs Case Manag, 1999,4(2):80-84. pmid: 10418459
[2]	O'HearnUlch PA, Schmidt MM . Clinical nurse specialist as community-based nurse case manager:integral to achieving the triple aim of healthcare[J]. Nurse Lead, 2013,11(3):32-35.
[3]	Woodward J, Rice E . Case management[J]. Nurs Clin N Am, 2015,50(1):109-121. doi: 10.1016/j.cnur.2014.10.009
[4]	Trueman SWT . Case management down under[J]. Prof Case Manag, 2011,16(4):217. doi: 10.1097/NCM.0b013e31821dbab0 pmid: 21646899
[5]	Lukersmith S, Millington M, Salvador-Carulla L . What is case management? A scoping and mapping review[J]. Int J Integr Care, 2016,16(4):2. doi: 10.5334/ijic.2477 pmid: 28413368
[6]	CMSA. Standards of practice for case management[R]. Little Rock:Arkansas, 1995.
[7]	McCullough L . The case manager:an essential link in quality care[J]. Creat Nurs, 2009,15(3):124-126. doi: 10.1891/1078-4535.15.3.124 pmid: 19715093
[8]	甘莉, 林侑华, 杨蓉 . 台湾地区护理个案管理的发展及现状[J]. 护理研究, 2014,28(12C):4491-4493.
	Gan L, Lin YH, Yang R . Development and status quo of nursing case management in Taiwan area[J]. Chin Nurs Res, 2014,28(12C):4491-4493.
[9]	薛美琴, 张玲娟 . 个案管理模式在我国的应用及思考[J]. 中华护理杂志, 2014,49(3):367-371.
	Xue MQ, Zhang LJ . The delivery and inspiration of case management model in China[J]. Chin J Nurs, 2014,49(3):367-371.
[10]	Welch G, Garb J, Zagarins S , et al. Nurse diabetes case management interventions and blood glucose control:results of a meta-analysis[J]. Diabetes Res Clin Pract, 2010,88(1):1-6. doi: 10.1016/j.diabres.2009.12.026 pmid: 20116879
[11]	Lin HY, Chen SC, Peng HL , et al. Effects of a case management program on patients with oral precancerous lesions:a randomized controlled trial[J]. Support Care Cancer, 2016,24(1):275-284. doi: 10.1007/s00520-015-2787-5 pmid: 26024744
[12]	Joo JY, Liu MF . Case management effectiveness in reducing hospital use:a systematic review[J]. Int Nurs Rev, 2017,64(2):296-308. doi: 10.1111/inr.12335 pmid: 27861853
[13]	Gouveia WA, Massaro FJ . Critical pathway experience at New England Medical Center[J]. Am J Heal-Syst Pharm, 1995,52(10):1068-1070.
[14]	张千竹 . 基于大数据的临床路径优化诊疗的研究[D]. 青岛:青岛科技大学, 2018.
	Zhang QZ . Research on clinical pathway optimization diagnosis and treatment based on big data[D]. Qingdao:Qingdao University of Science & Technology, 2018.
[15]	Restelli U, Croce D, Milella F , et al. Re-organisation of the management of patients affected with chronic pathologies in Lombardy Region:critical points associated with the management of HIV positive patients[J]. J Prev Med Hyg, 2018,59(4):E301-E304. doi: 10.15167/2421-4248/jpmh2018.59.4.919 pmid: 30656232
[16]	Bleich C, Büscher C, Melchior H , et al. Effectiveness of case management as a cross-sectoral healthcare provision for women with breast cancer[J]. Psycho-Oncology, 2017,26(3):354-360. doi: 10.1002/pon.4139 pmid: 27151147
[17]	Muluk SC, Painter L, Sile S , et al. Utility of clinical pathway and prospective case management to achieve cost and hospital stay reduction for aortic aneurysm surgery at a tertiary care hospital[J]. J Vasc Surg, 1997,25(1):84-93. doi: 10.1016/s0741-5214(97)70324-0 pmid: 9013911
[18]	刘春燕, 吴桂琴, 邵琳 , 等. 临床路径与个案管理在非体外循环冠状动脉搭桥手术中的应用[J]. 吉林医学, 2016,37(10):2602-2604.
	Liu CY, Wu GQ, Shao L , et al. Application of clinical pathway and case management in off-pump coronary artery bypass surgery[J]. Jilin Med J, 2016,37(10):2602-2604.
[19]	陈乐乐 . 慢性病管理效果及影响因素研究[D]. 厦门:厦门大学, 2018.
	Tao LL . Research on the effectiveness of managing chronic diseases and its influencing factors[D]. Xiamen:Xiamen University, 2018.
[20]	王璐, 朱晓萍, 田梅梅 , 等. 个案管理模式在糖尿病患者护理中的应用现状[J]. 护士进修杂志, 2018,33(2):121-124.
	Wang L, Zhu XP, Tian MM , et al. Application status of case management model in nursing care of diabetic patients[J]. J Nurses Train, 2018,33(2):121-124.
[21]	Watts SA, Sood A . Diabetes nurse case management:improving glucose control:10 years of quality improvement follow-up data[J]. Appl Nurs Res, 2016,29:202-205. doi: 10.1016/j.apnr.2015.03.011 pmid: 26856514
[22]	Ji H, Chen RH, Huang Y , et al. Effect of simulation education and case management on glycemic control in type 2 diabetes[J]. Diabetes Metab Res Rev, 2019,35(3):e3112. doi: 10.1002/dmrr.3112 pmid: 30520255
[23]	陈运香, 李小芒, 秦云山 , 等. 对糖尿病前期人群进行家庭参与式个案管理的效果评价[J]. 护士进修杂志, 2019,34(12):1133-1136.
	Chen YX, Li XM, Qin YS , et al. Evaluation of the effect of family participatory case management on prediabetes[J]. J Nurses Train, 2019,34(12):1133-1136.
[24]	周建萍 . 个案管理对肺癌患者疼痛症状的影响[J]. 护理实践与研究, 2018,15(24):97-98.
	Zhou JP . The influence of case management on the pain symptoms of lung cancer patients[J]. Nurs Pract Res, 2018,15(24):97-98.
[25]	严明珠, 马智勇, 赵艳秋 , 等. 个案管理模式对肺癌化疗患者生活质量及自我感受负担的影响[J]. 郑州大学学报(医学版), 2018,53(2):241-245.
	Yan MZ, Ma ZY, Zhao YQ , et al. Effects of case management model on quality of life and self-perceived burden in lung cancer patients with chemotherapy[J]. J Zhengzhou Univ Med Sci, 2018,53(2):241-245.
[26]	张惠婷, 张晶晶, 吴晓丹 , 等. 乳腺癌患者个案管理模式的探索[J]. 护理学杂志, 2017,32(14):19-21.
	Zhang HT, Zhang JJ, Wu XD , et al. Exploration of case management model for breast cancer patients[J]. J Nurs Sci, 2017,32(14):19-21.
[27]	Cicutto L, Gleason M, Haas-Howard C , et al. Building bridges for asthma care program:a school-centered program connecting schools,families,and community health-care providers[J]. J Sch Nurs, 2020,36(3):168-180. doi: 10.1177/1059840518805824 pmid: 30336726
[28]	庄英, 段霞, 王毅 , 等. 个案管理模式在冠心病患者中的应用研究进展[J]. 护理学杂志, 2019,34(21):110-113.
	Zhuang Y, Duan X, Wang Y , et al. Research progress on the application of case management model in patients with coronary heart disease[J]. J Nurs Sci, 2019,34(21):110-113.
[29]	刘晓青, 金爱萍, 董琼 , 等. 脑卒中病人个案管理的研究及应用进展[J]. 护理研究, 2018,32(3):336-339.
	Liu XQ, Jin AP, Dong Q , et al. Research and application pro-gress case management on stroke patients[J]. Chin Nurs Res, 2018,32(3):336-339.
[30]	Low S, Lim SC, Wang JX , et al. Long-term outcomes of patients with type 2 diabetes attending a multidisciplinary diabetes kidney disease clinic[J]. J Diabetes,2018,10(7):572-580. doi: 10.1111/1753-0407.12626 pmid: 29154443
[31]	Rümenapf G, Geiger S, Schneider B, et al. Readmissions of patients with diabetes mellitus and foot ulcers after infra-popliteal bypass surgery-attacking the problem by an integrated case management model[J]. Vasa, 2013,42(1):56-67. doi: 10.1024/0301-1526/a000235
[32]	Goodwin JS, Satish S, Anderson ET , et al. Effect of nurse case management on the treatment of older women with breast cancer[J]. J Am Geriatr Soc, 2003,51(9):1252-1259. doi: 10.1046/j.1532-5415.2003.51409.x pmid: 12919237
[33]	王宏 . 乳腺癌个案管理提高化疗完成率临床应用效果[J]. 岭南现代临床外科, 2016,16(4):413-415.
	Wang H . Case management of breast cancer promote the completion for chemotherapy:an investigation[J]. Lingnan Mod Clin Surg, 2016,16(4):413-415.
[34]	Li H, Sun XZ, Miller E , et al. BMI,reproductive factors,and breast cancer molecular subtypes:a case-control study and meta-analysis[J]. J Epidemiol, 2017,27(4):143-151. doi: 10.1016/j.je.2016.05.002 pmid: 28142040
[35]	Dinelli DL, Higgins JC . Case management of asthma for family practice patients:a pilot study[J]. Mil Med, 2002,167(3):231-234. pmid: 11901573
[36]	Chok L, Bachli EB, Steiger P , et al. Effect of diagnosis related groups implementation on the intensive care unit of a Swiss tertiary hospital:a cohort study[J]. BMC Heal Serv Res, 2018,18(1):84.
[37]	瞿佳, 宋雅云 . 我国个案管理研究的文献计量分析[J]. 护理学杂志, 2019,34(21):96-98.
	Qu J, Song YY . Biliometric analysis on case management studies in China[J]. J Nurs Sci, 2019,34(21):96-98.