Successes of a National Study of the Chronic Disease Self-Management Program Meeting the Triple Aim of Health Care Reform
Successes of a National Study of the Chronic Disease Self-Management Program Meeting the Triple Aim of Health Care Reform
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DOI：
10.1097/mlr.0b013e3182a95dd1
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发表时间：
2013-11-01
期刊：
影响因子：
3
通讯作者：
Lorig, Kate
中科院分区：
文献类型：
--
作者：
Ory, Marcia G.;Ahn, SangNam;Lorig, Kate
背景：新兴的卫生保健改革举措越来越重要，因为人们担心为越来越多的患有多种慢性病的成年人提供护理。循证自我管理策略被认为是通过改善慢性病的医疗、情感和社会角色管理需求来管理各种慢性病的核心。Objectives：在全国样本中，研究慢性病自我管理计划（CDSMP）的有效性，该计划的参与者围绕着三重目标（更好的健康、更好的医疗保健和更好的价值，即减少医疗保健的利用）进行组织。利用从小组CDSMP研讨会收集的数据，基线，6个月，使用3种类型的混合效应模型检查了12个月的评估，以提供干预效果的无偏估计。主题：分析了1170名社区居住CDSMP参与者的数据。措施：三重目标相关结果指标：更好的健康（如，自我报告的健康，疼痛，疲劳，抑郁），更好的医疗保健（如，病人-医生沟通，服药依从性，信心完成医疗表格），和更好的价值[如，减少急诊室（ER）访问和住院在过去6个月]。ER访问的几率显着降低，从基线到12个月的后续行动，而住院治疗显着减少，只观察到从基线到6个月follow-up.Conclusions：这个国家的研究CDSMP（国家研究）表明，成功的翻译CDSMP到广泛的实践和它的潜力，帮助国家实现三重目标的医疗保健改革。
Background:Emerging health care reform initiatives are of growing importance amidst concerns about providing care to increasing numbers of adults with multiple chronic conditions. Evidence-based self-management strategies are recognized as central to managing a variety of chronic diseases by improving the medical, emotional, and social role management demands of chronic conditions.Objectives:To examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among a national sample of participants organized around the Triple Aim goals of better health, better health care, and better value in terms of reduced health care utilization.Research Design:Utilizing data collected from small-group CDSMP workshops, baseline, 6-month, and 12-month assessments were examined using 3 types of mixed-effects models to provide unbiased estimates of intervention effects.Subjects:Data were analyzed from 1170 community-dwelling CDSMP participants.Measures:Triple Aim-related outcome measures: better health (eg, self-reported health, pain, fatigue, depression), better health care (eg, patient-physician communication, medication compliance, confidence completing medical forms), and better value [eg, reductions in emergency room (ER) visits and hospitalizations in the past 6 mo].Results:Significant improvements for all better health and better health care outcome measures were observed from baseline to 12-month follow-up. The odds of ER visits significantly reduced from baseline to 12-month follow-up, whereas significant reductions in hospitalization were only observed from baseline to 6-month follow-up.Conclusions:This National Study of CDSMP (National Study) demonstrates the successful translation of CDSMP into widespread practice and its potential for helping the nation achieve the triple aims of health care reform.