个案管理模式在慢性心力衰竭患者中应用的研究进展
| 作者: |
1张丽,
1崔德君,
1王娟娟,
2田梅梅
1 同济大学附属上海市第十人民医院心内科，上海 200072 2 同济大学附属上海市第十人民医院骨科，上海 200072 |
| 通讯: |
田梅梅
Email: plum2009@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.11.034 |
摘要
个案管理模式应用于疾病病程长，涉及多学科治疗照护的慢性疾病，为患者提供个性化、连续性的疾病照护模式，可以有效降低患者再入院率，提高其生活质量。目前国外主要包括出院计划、社区个案管理、标准电话随访以及居家监控4种个案管理模式，探索适合本土的个案管理模式对我国慢性心力衰竭患者具有重大意义。
关键词：
个案管理；慢性心力衰竭；护理
Research progress of case management model in patients with chronic heart failure
CorrespondingAuthor: TIAN Meimei Email: plum2009@126.com
DOI: 10.3978/j.issn.2095-6959.2019.11.034
Abstract
Case management model is applied to chronic diseases with long course of disease, involving multi-disciplinary treatment and care. Providing individualized and continuous disease care model for patients can effectively reduce the readmission rate of patients and improve their quality of life. In the present, the foreign case management includes discharge plan, community case management, standard telephone follow-up, and home stay. It’s of great value for Chinese patients with chronic heart failure to find a suitable case management model.
Keywords：
case management; chronic heart failure; nursing