Expanding the chronic care framework to improve diabetes management: the REACH case study.
Expanding the chronic care framework to improve diabetes management: the REACH case study.
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DOI：
10.1353/cpr.0.0108
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发表时间：
2010-01-01
期刊：
影响因子：
--
通讯作者：
Zapka, Jane
中科院分区：
文献类型：
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作者：
Jenkins, Carolyn;Pope, Charlene;Zapka, Jane
背景：减少少数民族慢性病的负担需要新的方法来预防和管理疾病。目的：本文描述了慢性护理模式(CCM)的扩展，以包括社区关注的改善糖尿病自我管理和减少健康差异。方法：文献综述评估了慢性病CCM支持者所认为的改善预后的“社区”概念。结果：根据我们在社区和卫生系统糖尿病干预方面的经验，我们展示了在卫生提供实践场所和其他社区系统内改善糖尿病预后的例子，这对于改善糖尿病预后和减少差异是至关重要的。基于疾病控制和预防中心(CDC)的社区参与原则，我们的联盟活动提供了与社区合作伙伴合作的例子，以框架这种增强的生态基础社区CCCM(CCCM)。结论：由此产生的CCCM整合了扩展的概念框架、基于证据的实践、基于社区的证据和参与性行动，并强调了通过促进个人、系统、社区和政策变化的社区计划来改善慢性病结果和减少差距的可能性和挑战。
BACKGROUND: Reducing the burden of chronic conditions among minorities requires novel approaches to prevent and manage disease.OBJECTIVES: This paper describes the expansion of the Chronic Care Model (CCM) to include a community focus for improving diabetes self-management and reducing health disparities.METHODS: The literature review assesses the concept of "community" in improving outcomes as viewed by proponents of the CCM for chronic disease. The CCM was then modified and informed by experiences of a major community-based participatory action initiative to improve diabetes outcomes, the Racial and Ethnic Approaches to Community Health (REACH) Charleston and Georgetown Diabetes Coalition.RESULTS: Based on our experiences with community-based and health systems diabetes interventions, we present examples of improvements within both health delivery practice sites and other community systems that are essential for improving diabetes outcomes and reducing disparities. Building on the Centers for Disease Control and Prevention's (CDC) principles of community involvement, our coalition activities provide examples of working with community partners to frame this enhanced ecologically grounded Community CCM (CCCM).CONCLUSION: The resulting CCCM integrates expanded conceptual frameworks, evidence-based practice, community-based evidence and participatory actions, and highlights the possibilities and challenges for improving chronic disease outcomes and reducing disparities via community programs that foster individual, systems, community, and policy change.