Analysis of integrated healthcare model for Chronic Obstructive Pulmonary Disease patients
10.3969/j.issn.1674-2982.2017.07.006
- VernacularTitle:COPD患者整合照护模式分析及相关策略研究
- Author:
Xiaohong ZHONG
;
Heng QIU
;
Haijin ZHAO
;
Shunfang ZHU
;
Yang LI
;
Kang HUANG
;
Renwen GENG
- Keywords:
Chronic Obstructive Pulmonary Disease;
Integrated care;
Literature analysis
- From:
Chinese Journal of Health Policy
2017;10(7):33-40
- CountryChina
- Language:Chinese
-
Abstract:
Objective: The aim of this paper is to identify the basic organizational structure and the key elements of integrated healthcare model of patients with Chronic Obstructive Pulmonary Disease (COPD) and propose an appropriate development strategy.Methods: Based on the literature review of research articles about integrated care on patients with COPD, an analysis was conducted with the help of the Chronic Care Model (CCM) which is a chronic disease management model.Results: From of a total 16 articles about 13 case studies were found.An integrated healthcare of COPD was carried out in 10 hospital-based or community-based care programs.Most of the patients were the elderly and health status were moderately severe or more severe.The components of healthcare programs varied from 4 to 12 included at least two CCM dimension.A coordinator or a case manager was appointed in all healthcare programs and a follow-up plan was made as well.Decision making was supported by clinic guideline and specialist resource in 9 integrated healthcare programs which community facilities involved.All programs included self-management with health education and individualized behavioral support was in 10 programs.The action plan was applied in 8 studies.8 studies using a clinical information system connected health care provider and patients.Conclusions: COPD integrated care program can be constructed according to the management model of chronic disease, and it is suggested that we can organize the COPD integrated care program based on CCM and the program comprises 4 organizational components of at least two CCM dimensions.The key elements of COPD integrated healthcare are to appoint a coordinator, to make a follow-up plan, and the necessity of community participation to support decision making, support self-management by education and individualized behavioral management with an action plan.
