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|本期目录/Table of Contents|

老年慢性心力衰竭患者的社区管理路径与组织技术保障

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2016年第1期
页码:
114-116
栏目:
综述
出版日期:
2015-09-15

文章信息/Info

Title:
Community management pathway and Organizational Guarantee of elderly patients with chronic heart failure
作者:
邓如芳1; 孙晓华2; 刘爱英2
（1.张家口市桥东区卫生监督所，河北 张家口 075000；
2.张家口市妇幼保健院内科，河北 张家口 075000）
Author(s):
DENG Ru-fang1;  SUN Xiao-hua2;  LIU Ai-ying2
(1.Health Supervision Institute, Qiaodong District, Zhangjiakou；
Zhangjiakou 075000, Hebei, China；
2.Internal Medicine, Maternal and Child Health Hospital, Zhangjiakou 075000, Hebei, China）
关键词:
慢病管理; 心力衰竭; 慢性; 老年; 社区卫生服务; 关键技术; 管理路径
Keywords:
chronic disease management;  heart failure;  chronic;  elderly;  community health service;  key technology;  management path
分类号:
R541.6
DOI:
-
文献标识码:
A
摘要:
通过对慢性心力衰竭患者（CHF）、卫生保健人员和政策层面共同干预，探索老年CHF患者社区管理路径与组织技术的集成。利用生物、心理和社会因素组成的综合干预方式,实现对个体疾病的管理，形成一整套科学、系统的路径指南。这套路径指南不仅创新了CHF患者社区管理新模式，还能减少医疗资源的浪费,增加病人患者的自我满足感,也提高了CHF患者生存质量。
Abstract:
In patients being treated for chronic heart failure (CHF), a common intervention in health care professionals and at the policy level is the integrated exploration in elderly patients with CHF using community management path and organization technology. Comprehensive intervention using biological, psychological and social factors comprise the team and carry out individual disease management, guiding the route for establishing a scientific system. This path is not only an innovative guiding mode for community management of patients with CHF but also reduces waste of medical resources and increases patient satisfaction, while also improving the quality of life of patients with CHF.

参考文献/References

[1]Wagner EH,Austin BT,Davis C,et al.Improving chronic illness care: translating evidence into action[J].Health Aff (Millwood),2001,20(6):64-78.
[2]Wagner EH.Chronic disease management:what will it take to improve care for chronic illness?[J].Eff Clin Pract,1999,1(1):2-4.
[3]Fireman B,Bartlett J,Selby J.Can disease management reduce health care costs by improving quality?[J].Health Aff(Millwood),2004,23(6):63-75.
[4]刘爱英,温亚彬,李文英,等. 无缝式社区管理用于老年慢性心力衰竭患者的效果观察[J].心脏杂志,2014,26(5):588-590,594.
[5]邓如芳,刘爱英.社区医院一体化管理用于老年慢性心力衰竭的社会效益观察[J].心脏杂志, 2014, 26(2):203-206.
[6]刘爱英,邓如芳,李文英,等.无缝式社区管理对老年慢性心力衰竭患者心功能的影响[J].心脏杂志,2014,26(2):210-213.
[7]孙晓华,邓如芳,刘爱英,等.心肺复苏技能培训效果在心脏病患者家属与一般人群间的比较[J].心脏杂志,2014,26(6):702-704.
[8]Garg AX,Adhikari NK,Mcdonald H,et al.Effects of computerized clinical decision support systems on practitioner performance and patient outcomes:a systematic review[J].JAMA, 2005,293(10):1223-1238.
[9]雷松蕙,朱秀娥,李 娉.对社区老年慢性病管理的体会[J].中国医学实践杂志,2006,5(8):12-13.

备注/Memo

备注/Memo:
收稿日期：2014-08-13.
作者简介：邓如芳，主治医师 Email：870250985@qq.com
更新日期/Last Update: 2015-09-16