基于信息化的新型慢性病管理模式探索

<正>随着松江区近年社会经济的快速发展、人们生活方式的变化和人口老龄化,慢性非传染性疾病(简称慢性病)已成为影响松江居民健康最主要的因素。由于慢性病大多是终生性疾病,病程长,耗资巨大,难以在短时间内见到明显预防与控制效果,因此慢性病防治显得尤为重要。1主要问题1.1多方因素导致慢性病人口快速增加近年来社会人群的行为方式、膳食结构、消费娱乐方式、工作内容与工作方式以     

适合高校社区慢性病管理模式的探索与实践

在社区开展慢性病管理,将疾病的事后治疗转为事前预防,可以有效降低个人或群体的健康风险,降低医疗资源的浪费,提高现代人的健康寿命和生活质量。随着国家经济社会快速发展和人们生活水平的稳步提高,慢性病对人类健康的威胁也在不断升级。中国2000年全国死亡人数731万,近600万是慢性病患者,2008年慢性病总例数达2.6     

慢性病社区综合健康管理模式与成效

健康管理作为新的卫生服务理念,与社区卫生服务具有互相促进、互相补充的关系,共同服务于慢性病防治工作,为健康管理和社区卫生服务提供了整合的平台。明楼街道社区卫生服务中心在尊重国情、整合现有社区卫生服务资源的基础上,尝试探索社区慢性病综合健康管理服务模式,取得了一定特色的成效。     

上海市实施整合式慢性病社区健康管理模式的促进和障碍因素

目的 分析整合式慢性病社区健康管理模式实施的促进和障碍因素,区分模式服务量高覆盖率组和低覆盖率组在实施性研究的整合性理论框架(consolidated framework for implementation research,CFIR)上的结构差异,为政府部门提供政策建议。方法 结合CFIR对22名专家进行半结构化访谈,采用定性结构评级法对13家社区卫生服务中心受访者评分,利用NVivo 12软件编码。结果 高覆盖率组和低覆盖率组的相对优势、外部政策与激励、实施准备度、反思和评价、领导个人特质5个CFIR结构有差异。促进因素包括:测量数据更加精准,提高了高血压和糖尿病患者的异常检出率和控制率;模式实现了服务、技术、数据“三整合”,优化管理流程,提供管理抓手;基础性和个性化服务结合吸引患者到基层就诊;模式与我国政策背景,初级卫生保健工作和以患者为中心理念兼容;数字化工具的应用减轻医护人员工作负担;领导重视是基础,利益方间的通力合作是重要保障。障碍因素包括:宏观层面缺少卫生行政机构的支持性政策,组织架构和运行机制尚未建立,建设、投入主体以及具体工作规范和流程有待明确;缺乏监督管理机制和质...     

论社区慢性病健康教育

我国自1986年起即开始人群健康教育和危险因素干预的研究。“八五”期间,在上海、北京、长沙3个城市和北京房山区农村进行了心脑血管疾病危险因素的干预性研究,通过各种形式的健康教育和健康促进活动,并重点管理和监测35岁以上高血压患者。随访4年结果表明,干预社区冠心病平均病死率为32.8/10万,较几年前明显降低。对照社区44.8/10万,两组相比差异有统计学意义。     

北京市昌平区慢性病社区健康管理模式探讨

慢性病受多种因素长期影响所致,多病因、多基因、多阶段、潜伏期长,通常认为导致慢性病的主要危险因素包括不合理膳食,脂肪摄入过多,蔬菜水果摄人不足;长期吸烟、酗酒;久坐的生活方式,体力活动不足;超重和肥胖;高血压、高血脂;家族遗传史;精神紧张,心理适应不良;环境污染与职业危害等。     

慢性病和社区健康管理

经济发展、人口老龄化和不良的生活方式等等使得慢性非传染性疾病(简称慢性病)大幅增加,已严重地威胁了人民的健康和生活质量.转变医学模式,合理利用医疗资源,在社区卫生机构建立针对慢性病的健康管理,对发挥社区卫生机构的优势,增强人们预防疾病和自我保健的意识都有积极作用.     

网格化管理 信息化支撑 建立城市社区慢性病管理新模式——北京市东城区数字化慢性病管理模式探索

建立一套科学的社区卫生服务运行和管理机制是扎实开展社区慢性病管理工作的前提和保障.东城区通过建立以政府主导、网格化管理、信息化支撑为特色的新型数字化慢性病管理模式,初步实现了慢性病管理工作的规范化、系统化和精细化,取得了明显成效.     

基于"主动健康"理念的社区慢性病管理模式研究

"主动健康"是"健康中国"行动的重要举措,是健康医学未来发展的一种新模式.将"主动健康"理念融入社区慢性病管理,在政府引导和医院参与的基础上,社区、家庭和个人多方协作,建立支持性的健康维护环境,通过引导积极的生活方式等干预措施,使居民由"被动健康"到"主动健康",从而获得保持健康和预防疾病的能力,真正实现慢性病防治关口...     

社区慢性病防治的健康教育

慢性非传染性疾病是以恶性肿瘤、心脑血管疾病、糖尿病、Alzheimer病为代表的一组疾病，有迁延性、无自愈和极少治愈等特征。这些疾病不仅与生物环境因素有关，而且与心理社会因素有密切的关系。健康教育可以让慢性病高危人群和一般人群掌握健康的基本知识和保健的基本技能，改变不良的生活方式，提高自我保健能力，预防或延缓疾病的发生、发展，同时对临床治疗也具有积极的意义。WHO指出，加世纪后半叶全球最显著的健康转变乃是慢性非传染性疾病迅速上升。不仅发达国家如此，发展中国家也面临着同样的挑战。因此，许多国家和地区都针对慢性非传染性疾病开展了一系列行之有效的健康教育和健康促进活动，为此，我们需结合我国国情充分发挥健康教育在社区慢性病防治工作中的作用。     

慢性非传染性疾病的社区健康教育效果分析

目的了解社区慢性非传染性疾病的健康教育效果。方法采用统一格式的调查问卷表,以随机抽样的方式,选取深圳市盐田区4个社区817名居民开展社区健康教育和健康促进活动,调查干预前后相关卫生知识知晓率、行为危险因素以及慢病管治率变化情况。结果实施健康教育后,居民健康知识知晓率有明显提高,如确诊高血压诊断标准、成人每日食盐摄入标准、高血压是终身慢性疾病、确诊糖尿病诊断标准、糖尿病的并发症可导致残疾的正确回答率分别由原来的21.1%、32.3%、11.3%、6.9%、10.1%提高到77.7%、83.6%、65.9%、60.2%、61.3%(P<0.01);吸烟人数由原来的41.1%下降至35.1%(P<0.05),居民平均每天食盐摄入量≤6 g的人数和参加体育锻炼人数明显增加,分别从原来的58.6%、39.3%提高到89.2%、61.1%(P<0.01);居民健康教育前后高血压、糖尿病患者管理率分别由原来的60.2%、52.8%提高到95.1%、90.3%(P<0.01)。结论在社区开展以健康教育为主要形式的行为危险因素干预是防治慢性非传染性疾病的有效措施。     

Diabetes disease management in a community-based setting

PURPOSE: The medical cost of diabetes in the United States in 1997 was at least $98 billion. This study illustrates the behavioral change and medical-care utilization impact that occurs in a community-based setting of a diabetes disease-management program that is applied to program participants in a health insurance plan's health maintenance organization and preferred provider organization. DESIGN: A historical control comparison of diabetes-management participants. METHODOLOGY: One hundred twenty-seven identified diabetes patients are followed from baseline through 1 year. Differences in behavior are compared at program intake and at a 6-month reassessment. Differences in medical-service utilization are compared in the baseline year and the year subsequent to program enrollment. Poisson multivariate-regression models are estimated for counts of inpatient, emergency department, physician evaluation and management, and facility visits, while also controlling for potential confounders. PRINCIPAL FINDINGS: Behaviors improved between program intake and the 6-month reassessment. From patient reports, the number of participants having a hemoglobin A1c test increased by 44.9 percent (p < .001), and there was a 53.2-percent decrease in symptoms of hyperglycemia (p = .002). From medical claims after program enrollment, a drop occurred during the program year in every dimension of medical-service utilization. Regression results show that in-patient admissions decreased by 391 (p < .001) per 1,000 for each group, while controlling for age, length of membership, and the number of comorbid claims for congestive heart failure. In the analysis of costs that were pre- and post-enrollment, which included disease-management program costs, a 4.34:1 return on investment was calculated. CONCLUSION: The diabetes program provides patients with comprehensive information and counseling relative to practicing self-management of diabetes through a number of integrated program components. This study strongly suggests that the implementation of such a program is associated with positive behavioral change and, thus, with substantial reduction in medical-service utilization. In addition, the intervention resulted in a net decrease in direct medical costs.     

An integrated inpatient management model

The academic health center has emerged as the cornerstone of the American health care system. To assess the vulnerability of the academic medical center to the new competitive forces that exist today, a prototype project has been developed that attempts to address the issue of competition in clinical activity, while at the same time enhancing the academic health center's education and research roles.     

Searching bibliographic databases for literature on chronic disease and work participation

BACKGROUND: The work participation of people with chronic diseases is a growing concern within the field of occupational medicine. Information on this topic is dispersed across a variety of data sources, making it difficult for health professionals to find relevant studies for literature reviews and guidelines. AIM: The goal of this project was to identify bibliographic databases and search terms that could be most useful for retrieving relevant studies on this topic. METHODS: Five broad questions regarding work participation and chronic disease were formulated, focusing on angina pectoris, depression, diabetes mellitus, hearing impairment and rheumatoid arthritis. A search strategy for retrieving information on these questions was developed and run in five bibliographic databases: Medline, EMBASE, PsycINFO, Cinahl and OSHROM. Relevant publications were selected from the search results. The utility of the selected databases and search terms was evaluated by analysing the number of relevant publications that were retrieved. RESULTS: The number of relevant publications retrieved from each database varied. Most (84%) of the relevant publications that were retrieved from each database were unique to that source. For each database, specific search terms for the concept of 'work' were useful for retrieving relevant publications. CONCLUSION: Medline, EMBASE and PsycINFO are useful databases for quick searches. Useful search terms for the concept of 'work' are work capacity, work disability, vocational rehabilitation, occupational health, sick leave, absenteeism, return to work, retirement, employment status and work status. For comprehensive searches, we recommend additional searches in Cinahl and OSHROM, adapting the search terms to specific databases.     

Nutritional modulation as part of the integrated management of chronic obstructive pulmonary disease

Weight loss is a frequent complication in patients with chronic obstructive pulmonary disease (COPD) and is a determining factor for functional capacity, health status and mortality. Weight loss in COPD is a consequence of an inbalance between increased energy requirements and dietary intake. Both metabolic and mechanical inefficiency may contribute to elevated energy expenditure during physical activity, while systemic inflammation has been associated with hypermetabolism at rest. Disease-specific symptoms and systemic inflammation may impair appetite and dietary intake. Altered intermediary metabolism may cause disproportionate wasting of fat-free mass in some patients. A combination of nutritional support and exercise as an anabolic stimulus appears to be the best approach to obtaining marked functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. The effectiveness of anti-catabolic modulation requires further investigation.