个案管理模式在疾病管理中的临床实践

Practice and application of case management model in disease management

我院在借鉴我国台湾个案管理经验的基础上,建立了个案管理模式。通过建立个案管理岗位、进行规范化个案管理师培训、建构完善的品质管理体系,为患者及其家属提供持续性及协调性的全程照护服务,促进其参与健康及疾病自我管理,进而达到控制就医成本和改善生活品质的护理目标。本文旨在通过分享个案管理模式在疾病管理中的实践及其推展后的成效,以期为个案管理在疾病全程管理中的应用提供借鉴。

Our hospital set up a case management model based on the experiences of case management in Taiwan. Through the establishment of case management and standardized case manager training program, we set up a quality management model for patients and their families. We provided continuous whole care services and promoted the patients and their families to participate in health and disease self-management, in order to reduce the medical expenses and improve the quality of life. It is expected to provide information for the further development of case management through sharing the practice and effectiveness of case management.