Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework

As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.

Chronic care model in the diabetes pay-for-performance program in Taiwan:Benefits,challenges and future directions

In this review,we discuss the chronic care model(CCM)in relation to the diabetes pay-for-performance(P4P)program in Taiwan.We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan,mapping them onto the 6 components of the CCM.For each CCM component,the following three topics are described:the definition of the CCM component,the general activities implemented related to this component,and practical and empirical practices based on hospital or local government cases.We then conclude by describing the possible successful features of this P4P program and its challenges and future directions.We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives(i.e.,shared care network),physician-led P4P and the implementation of activities based on the CCM components.However,due to the low rate of P4P program coverage,approximately 50%of patients with diabetes cannot enjoy the benefits of CCMrelated activities or receive necessary examinations.In addition,most of these CCM-related activities are not allotted an adequate amount of incentives,and these activities are mainly implemented in hospitals,which compared with primary care providers,are unable to execute these activities flexibly.All of these issues,as well as insufficient implementation of the e-CCM model,could hinder the advanced improvement of diabetes care in Taiwan.

Social Capital and Depressive Ill-Health——An Evaluative Approach to the Implementation of the Chronic Care Model (CCM)

Background: Social capital has been described as a person’s sense of belonging as a result of the number and type of relationships she/he has, in which trust and reciprocity are especially important. Aim: To illuminate older persons’ experiences of social capital and depressive ill-health after implementation of the CCM. Methods: Data were collected from nine participants resident in two districts of Norway by means of individual in-depth interviews. A qualitative hermeneutic analysis was performed. Results: Two overall themes, desire for a guardian and a wish for independence despite being dependent, and two themes emerging from the analysis. The first theme—searching for protection was based on three sub-themes overwhelmed by the emotional pain of other people, a sense of exclusion and worries about the future, while the second theme—the need for a relationship with trustworthy persons comprised two sub-themes, namely, emotional pain was not understood and powerlessness to change the situation. The result of this study highlights the need for greater understanding on the part of healthcare professionals of how older persons manage their social relationships. Healthcare professionals require more knowledge about how negative self-beliefs held by older persons suffering from emotional pain, which can lead to reduced ability to trust other people. Another consequence is that fear of being dependent on other people can result in unwillingness to admit the need for help. Conclusion: This study highlights the lack of social capital in older persons who suffer from depressive ill-health. The implementation of the CCM does not appear to improve the situation. Older persons need to be more aware of their social needs and productive interactions in order to protect themselves and obtain support from their social network.

Shared Decision-Making after Implementation of the Chronic Care Model (CCM)—An Evaluative Approach

Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.

Adapting chronic care models for diabetes care delivery in low-and-middle-income countries:A review

A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.

Depressed Older Patients’ Need for and Expectations of Improved Health Services—An Evaluative Approach to the Chronic Care Model

Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.

Discussion on the Application of American Chronic Disease Management Model in China

With the rapid development of economy and society, chronic diseases generally show the incidence, mortality, morbidity, but the awareness rate, treatment rate, low control rate of the ＂three high three low＂ phenomenon. The results of the fifth national health service survey in 2013 show that the prevalence of chronic diseases among the population aged 15 and over is 33.1%, which means that there are 375 million cases of chronic diseases diagnosed by doctors in our country. Chronic diseases have become a serious threat to human health, public health problems, reduce chronic disease mortality and disease burden is the main goal of health strategy. At present, medical and health needs are growing, and health and medical resources are limited. In the past, the disease-centered medical treatment model can not solve the above contradictions, and then the individual and group health as the center of the chronic disease management model continues to appear, chronic disease management also will become The focus of global attention. Foreign exploration of chronic disease management model started earlier, in which the United States chronic disease care model is widely respected and applied.

Evaluating Improvement in the Care of Depressed Elderly Patients: An Empirical Approach to the WHO Patient Safety Model

Depression among the elderly is a public health issue. This paper demonstrates the value of patient safety research for future strategies in this area. The aim of the present study was to analyse the relationship between the World Health Organization (WHO) Patient Safety (PS) Model and empirical research on depressed elderly patients’ experiences of quality and safe care. The research question was: Which patients’ experiences could be linked to quality and safe care as recommended by the WHO? We adopted an implementation approach as the starting point for this interdisciplinary project. A total of 29 individual narrative-based, in-depth interviews were performed to explore patients’ experiences and two healthcare teams participated in the focus group interviews. Interpretation of the results revealed that the 23 components of the PS model were linked to elderly patients’ experiences of quality and that safe care was not achieved. There was evidence of low quality and lack of safe care due to psychological distress, stress and fatigue, the absence of involvement in decision-making, misdiagnosis, sleep problems as a result of harm from medical error and a poor physical state. Patients’ experiences of loneliness gave rise to suicidal thoughts. In conclusion, quality improvement is necessary in all components of the WHO PS model. We recommend structural, process and outcome improvements, more specifically: active involvement, shared decision-making and increased self-management.

Easy Breathing—Definition of a Gamification System to Support the Chronic Care of Childhood Asthma

Asthma is the most common noncommunicable disease among children. It leads to substantial problems both in health and economic terms to individuals and families. This paper introduces a technological solution, Easy Breathing, that supports the man-agement of childhood asthma, providing tools for both doctors and patients. Through the establishment of an asthma chronic care model, it combines doctors’ professional guidance and a gamification system to improve the compliance of patients with their treatments and to provide them with tools for the self-management of their disease. The system is in the testing phase, the first mockup has been developed and validated with 270 medical experts and patients, and it will be tested with 540 end-users over the next months.

Guided Care模式在老年慢性疾病管理中的应用

目的探讨Guided Care护理模式在老年慢性疾病管理中的应用效果。方法选择160例老年患者为研究对象,分为干预组和对照组,对照组实施常规护理及健康教育,干预组实施Guided Care护理方案,干预6个月后比较两组患者的日常生活能力、家庭功能、社会支持状况。结果干预组日常生活能力、家庭功能、社会支持得分高于对照组(P<0.01或P<0.05)。结论对老年慢性病患者实施Guided Care护理模式,提高了老年慢性病患者的日常生活能力,加强家庭功能和社会支持,改善老年慢性病患者的生活质量。

Guided Care管理模式对慢性心衰患者服药依从性、自我护理行为及生活质量的影响

目的探讨Guide Care管理模式对慢性心功能衰竭(CHF)患者服药依从性、自我护理行为和生活质量的影响。方法选取在我院接受治疗的90例CHF患者为研究对象,采用随机数字表法将其分为对照组和干预组,每组45例。对照组接受常规护理,干预组在对照组基础上给予Guided Care管理模式。比较两组护理效果。结果干预组ACEI/ARB、β受体阻滞剂、ACEI/ARB与β受体阻滞剂联用的应用比例及达到指南推荐靶剂量的患者比例均显著高于对照组(P<0.05)。两组MLHFQ、EHFScBS评分均呈现出先降低再升高的趋势。入院时和出院时,两组躯体领域、情绪领域评分和总分及EHFScBS评分比较,差异均无统计学意义(P>0.05);随访结束时,干预组的躯体领域、情绪领域评分和总分及EHFScBS评分均显著低于对照组(P<0.05)。结论 Guided Care管理模式应用于CHF患者中有助于改善患者的服药依从性,提高患者的自我护理行为和生活质量水平。

慢性阻塞性肺疾病管理中实施Guide Care护理模式的临床效果

目的:探究慢性阻塞性肺疾病(COPD)管理中实施Guide Care护理模式的临床效果。方法:选取60例COPD患者为研究对象,采用随机数字表法分为对照组和观察组各30例,对照组采用常规护理,观察组采用Guide Care护理模式。观察两组患者肺功能改善有效率及生命质量。结果:护理后,观察组肺功能改善有效率为96.67%,明显高于对照组的66.67%,差异有统计学意义(P<0.05);观察组患者生命质量评分量表(SF-36)评分均明显高于对照组,差异有统计学意义(P<0.05)。结论:慢性阻塞性肺疾病管理中实施Guide Care护理模式的临床效果显著,可推广应用。

问题导向模式联合预知护理在慢性阻塞性肺疾病患者中的应用

目的:探讨问题导向模式联合预知护理在慢性阻塞性肺疾病(COPD)患者中的应用效果。方法:选取2022年1月1日~2023年1月1日收治的120例COPD患者作为研究对象,遵循抽签双盲法分为对照组和研究组各60例,对照组实施预知护理干预,研究组在对照组基础上实施问题导向模式;比较两组干预前后肺功能指标、生活质量[采用圣乔治呼吸问卷(SGRQ)]、自我管理能力(采用自我管理量表)、自我护理能力[采用自我护理能力测定量表(ESCA)],并发症发生情况。结果:干预后,研究组肺功能各项指标、SGRQ评分、自我管理能力均优于对照组(P<0.01);干预后,两组ESCA评分均高于干预前(P<0.01),且研究组高于对照组(P<0.01);研究组并发症发生率低于对照组(P<0.05)。结论:问题导向模式联合预知护理在COPD患者中效果显著,可以有效改善患者肺功能,提高患者生活质量、自我护理及自我管理能力,从而降低并发症发生率。

慢性轨迹模式护理对靶向治疗肺癌患者的效果及价值分析

目的 探讨靶向治疗肺癌患者予以慢性病轨迹模式护理的效果。方法 选取2019年12月—2022年12月医院收治的120例接受靶向治疗的肺癌患者为研究对象,将患者按组间基本特征具有可比性的原则分为对照组和观察组,各60例,对照组患者实施常规护理,观察组患者实施慢性病轨迹模式护理。观察两组患者健康信念、自我管理效能、肿瘤标志物、癌因性疲乏因子及自我效能等指标水平变化情况。结果 护理后,观察组患者健康信念、自我决策、正性态度及自我减压水平高于对照组,差异具有统计学意义(P<0.05);观察组患者CEA、NSE、CA125及CA199水平低于对照组,差异具有统计学意义(P<0.05);观察组患者CFS量表中的躯体、情感、认知水平低于对照组,差异有统计学意义(P<0.05),观察组患者GSES评分高于对照组,差异有统计学意义(P<0.05)。结论 靶向治疗肺癌患者临床治疗中予以慢性病轨迹模式护理干预方案,可提高患者健康信念与自我管理能力,且还可有效降低其癌性疲乏因子状况,并能提升患者自我效能,进而可有效提高肿瘤标志物水平改善效果,提高疗效,可获得更理想的干预效果。

慢性肾脏病患者智能健康随访管理系统的构建及应用

目的基于慢性病管理模型构建智能健康随访管理系统,并评价其在慢性肾脏病患者中的应用效果。方法选取浙江省某三级甲等医院肾内科出院的慢性肾脏病患者172例,根据出院时间将患者分为对照组86例和观察组86例,对照组进行常规随访,观察组通过组建团队、搭建系统架构、建立专病数据库及开发应用模块构建的智能健康随访管理系统随访。干预6个月后比较两组自我管理能力、肾小球滤过率、血肌酐、尿微量白蛋白肌酐比值、收缩压、舒张压、BMI的差异。结果对照组84例、观察组85例完成研究。干预6个月后观察组自我管理能力评分显著高于对照组,肌酐、尿微量白蛋白肌酐比值、收缩压、舒张压、BMI值显著低于对照组(均P<0.05);干预前后两组肾小球滤过率比较无统计学差异(P>0.05)。结论基于慢性病管理模型的智能健康随访管理系统能提高慢性肾脏病患者的自我管理能力,延缓慢性肾脏病的进展。

基于PDSA理论构建医联体下老年共病整合管理模式

共病患病率的持续升高为人群健康管理带来了严峻挑战,世界卫生组织建议开发整合医疗照护模式应对共病人群健康管理压力。本文构建了一种基于PDSA理论的医联体下老年共病整合管理模式,以期在“计划-执行-学习-反馈”的往复循环中不断提升管理能力和效果。该模式由管理团队、管理流程、管理工具、管理效果4大关键要素组成。该模型在既往干预研究的基础上整合以患者为中心、多学科团队、患者自我管理等干预方式,依托大数据技术建立决策支持平台,实现共病患者的全生命周期健康管理。

安宁疗护在老年慢性阻塞性肺疾病患者中的应用效果

目的:观察安宁疗护在老年慢性阻塞性肺疾病(COPD)患者中的应用效果。方法:选取2020年12月至2022年6月该院收治的172例老年COPD患者进行前瞻性研究,按随机数字表法将其分为对照组与观察组各86例。对照组采用常规护理,观察组在对照组基础上采用安宁疗护,比较两组护理前后自我管理能力评分、疾病相关指标[COPD评估测试(CAT)评分、呼吸困难指数(MRC)评分、6分钟步行试验(6MWD)、第1秒用力呼气容积(FEV1)/用力肺活量(FVC)]水平和护理依从性评分。结果:护理后,两组日常生活能力、症状、自我效能、情绪及信息等自我管理能力评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);两组MRC、CAT评分均低于护理前,且观察组低于对照组,两组6MWD均长于护理前,且观察组长于对照组,两组FEV1/FVC水平均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组服药剂量、服药次数、遵医治疗、定期复查及运动指导等护理依从性评分均高于对照组,差异有统计学意义(P<0.05)。结论:在常规护理基础上采用安宁疗护应用于老年COPD患者可提高自我管理能力和护理依从性评分,改善疾病相关指标水平,其效果优于单纯常规护理。

家庭医生制度下医护团队模式干预在社区高血压疾病管理中的应用效果

目的:探讨家庭医生制度下医护团队模式干预对社区高血压疾病管理的应用效果。方法:选取2021年1月—2022年1月湖北中医药高等专科学校附属三板桥医院收治的高血压患者126例作为研究对象,依据随机数字表法分为两组,各63例。对照组实施常规干预,观察组实施家庭医生制度下医护团队模式干预。比较两组血压、依从性及高血压知识知晓率。结果:干预6个月后,两组收缩压、舒张压低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05);两组治疗依从性、护理依从性、自我管理依从性、预防行为依从性评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05);两组预防知识、危害、危险因素、高血压诊断知晓率高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:家庭医生制度下医护团队干预模式在社区高血压疾病管理中的应用效果较好,可有效控制患者血压水平,提升患者依从性及高血压知识知晓率。

江苏省三级医院慢性肾脏病患者对药学服务的满意度调查

目的为改善慢性肾脏病(CKD)患者对药学服务质量的满意度提供参考。方法采用分层抽样与随机抽样相结合的方法抽取江苏省内6家三级医院的CKD患者为调查对象。基于改良的SERVQUAL模型,从可靠性、响应性、移情性、保证性、连续性、有形性6个维度调查江苏省CKD患者对药学服务质量的评价,并分析6个维度对于整体满意度的影响程度。结果共发放205份问卷,回收有效问卷199份,有效率为97.07%。受访患者对CKD药学服务质量整体满意度不高,有60.30%的患者表示“勉强满意”,28.65%的患者表示“不满意”或“非常不满意”。6个维度的服务质量值(SQ)都小于0,6个维度均可以显著正向影响整体满意度,其中可靠性和响应性维度的服务质量评价最高(SQ平均值均为-1.01),保证性维度的服务质量评价最低(SQ平均值为-1.10)。结论江苏省CKD患者对药学服务质量的各维度评价及整体满意度较低。建议相关医疗机构重点关注保证性、有形性、移情性、连续性等维度,进一步加强对药师的业务技能培训、重视对患者的随访并及时完善硬件设施。

Orem自理模式结合康复训练在慢性阻塞性肺疾病患者中的应用效果观察

目的:探讨Orem自理模式结合康复训练在慢性阻塞性肺疾病患者中的应用效果。方法:选取2019年10月至2021年12月本院收治的慢性阻塞性肺疾病患者106例,根据随机数字表法分为Orem组和康复组各53例,所有患者给予常规治疗和护理措施,康复组给予康复训练干预,Orem组给予Orem自理模式结合康复训练干预,比较两组患者干预前后肺功能治疗和血气指标、自我护理能力评分,并对两组患者负性情绪和生活质量进行比较,统计两组患者护理满意度。结果:干预前两组患者肺功能指标、血气指标、自我护理能力评分差异无统计学意义(P>0.05);干预后,Orem组第1秒用力呼气容积(forced expiratory volume in one second, FEV1)、用力肺活量(forced vital capacity, FVC)和FEV1/FVC水平高于康复组(P<0.05);干预后,Orem组动脉血氧分压(partial pressure of oxygen, PaO2)和血氧饱和度(oxygen saturation, SpO2)水平高于康复组(P<0.05),自护技能、自护责任感、自我概念和自护知识评分高于康复组(P<0.05),抑郁自评量表(Self-Rating Depression Scale, SDS)和生存质量特异性量表(Diabetes Specific Quality of Life, QSQL)评分低于康复组(P<0.05),患者总满意度(96.23%)高于康复组(79.25%)(χ^(2)=10.610,P=0.005)。结论:Orem自理模式结合康复训练在慢性阻塞性肺疾病患者中的应用效果较好,可明显改善患者肺功能和血气指标,提高患者自我护理能力,改善患者焦虑情绪,提高生活质量,患者满意度较高,值得进一步推广应用。