As good as it gets? Chronic care management in nine leading US physician organisations
As good as it gets? Chronic care management in nine leading US physician organisations
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DOI：
10.1136/bmj.325.7370.958
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发表时间：
2002-10-26
影响因子：
105.7
通讯作者：
Robinson, JC
中科院分区：
文献类型：
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作者：
Rundall, TG;Shortell, SM;Robinson, JC
在美国生活的2.76亿人中，约有1.25亿人患有某种类型的慢性疾病（表1）。1四种慢性疾病影响着近一半患有慢性疾病的美国人：哮喘、抑郁症和糖尿病各影响约1500万人，2-4而500万人患有充血性心力衰竭。1999年，这四种慢性疾病直接导致美国14万人死亡，造成至少1730亿美元（1080亿英镑，1700亿欧元）的医疗和其他费用。在过去的十年中，通过护理管理过程的创新，如使用指南、疾病管理技术、病例管理和患者教育来改善慢性病的自我管理，改善了这些和其他主要慢性疾病患者的护理效果。然而，许多患者并没有从这些进步中受益。最近的研究表明，只有不到一半的美国哮喘、抑郁症和糖尿病患者接受了适当的治疗。11-13与有效慢性疾病护理相关的医师实践的组织特征包括使用患者护理团队、支持性信息系统和大量患者。因此，我们期望在美国，中型和大型的、组织良好的、多专业的实践可能会提供尽可能好的慢性病护理，并为其他医生组织提供可以衡量绩效的基准。
About 125 million of the 276 million people living in the United States have some type of chronic illness (table 1). 1 Four chronic conditions affect nearly half of Americans with a chronic disease: asthma, depression, and diabetes each affect about 15 million, 2–4 while five million have congestive heart failure. 5 In 1999 these four chronic diseases were directly responsible for 140 000 deaths in the United States6 and generated at least $173 bn (£ 108bn,€ 170bn) in medical and other costs. 5 7–9Over the past decade the effectiveness of care for patients with these and other major chronic illnesses has been improved by innovations in care management processes such as the use of guidelines, disease management techniques, case management, and patient education to improve self management of chronic disease. 10 However, many patients are not benefiting from these advances. Recent studies indicate that fewer than half of US patients with asthma, depression, and diabetes receive appropriate treatment. 11–13 Organisational characteristics of physician practices associated with effective chronic disease care include the use of patient care teams, supportive information systems, and a high volume of patients. 14 Hence, we expect that in the United States moderate and large sized, well organised, multispecialty practices are likely to offer chronic disease care that is as good as it gets and provide other physician organisations with benchmarks against which performance can be measured.