慢性疾病管理

“We have moved from understanding what is required to deliver excellent care for individual patients with chronic illnesses to the immense challenge of learning how to implement what we know works at scale: the science of health care delivery.”

迈克尔·帕奇曼，医学博士，公共卫生硕士
bwin必赢移动版 Health Research Institute 高级调查员

bwin国际活动概述

What do diabetes, back pain, depression, and heart disease have in common? They're among a host of chronic health problems and disabilities that have traditionally received too little attention from health care systems—until serious complications develop. Modern medicine tends to focus on detecting and treating acute problems, leaving fewer resources for the needs of chronically ill patients, 哪些可能不那么紧急，但同样重要.

Our population is aging rapidly, and people with chronic conditions are living longer. Chronic conditions now affect more than 145 million Americans. About half of Americans over 65—our nation’s fastest-growing segment—have at least two chronic conditions. 因为我们对改善慢性病护理的需求越来越大, health care delivery systems are trying to correct the many deficiencies in current management of chronic diseases.

“Much of our work now focuses on finding ways to give organizations the support and tools they need to build high-functioning health care teams that can engage patients, 提高其护理的质量和结果,” says 迈克尔·帕奇曼，医学博士，公共卫生硕士, senior investigator at bwin必赢移动版健康bwin国际活动所 (KPWHRI) and a researcher within its 麦考尔医疗创新中心.

"Meeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice,艾德·瓦格纳说。, MD, MPH, senior investigator and founder of KPWHRI’s MacColl Center.

近二十年来, KPWHRI的科学家一直在开发, 实现, and promoting better models of care for chronic illness. Widely recognized for its refinement and dissemination of the Chronic Care Model (CCM), the Institute’s MacColl Center continues to work with providers nationwide to develop strategies and tools for health care systems seeking to improve chronic illness care.

Such resources are then shared globally through active engagement with international organizations developing guidance and care recommendations. Providers worldwide continue to adapt materials such as MacColl’s Patient Assessment of Chronic Illness Care (PACIC) and Patient-Centered Medical Home Assessment (PCMH-A) surveys.

关于慢性疾病管理的最新出版物

瓦格纳是吗. Organizing care for patients with chronic illness revisited. 米尔班克问. 2019年9月,97 (3):659 - 664. doi: 10.1111/1468-0009.12416. 2019年8月19日. PubMed

舒特纳L，帕奇曼M. Team-based primary care for the multimorbid patient: matching complexity with complexity. 地中海是J. 2019年4月,132 (4):404 - 406. doi: 10.1016/j.amjmed.2018.09.029. 10月6日. PubMed

Groeneweg M, Forrester S, Arnold B, Palazzo L, Zhu W, Yoon P, Scearce T. One-year outcomes of an integrated multiple sclerosis disease management program. J Manag Care Spec Pharm. 2018年5月,24 (5):458 - 463. doi: 10.18553 / jmcp.2018.24.5.458. PubMed

Kligler B, Bair MJ, Banerjea R, DeBar L, Ezeji-Okoye S, Lisi A, Murphy JL, Sandbrink F, Cherkin DC. Clinical policy recommendations from the VHA state-of-the-art conference on non-pharmacological approaches to chronic musculoskeletal pain. J Gen实习医生. 2018年4月9日. pii: 10.1007/s11-z. doi: 10.1007/s11-z. [印刷前Epub]. PubMed

Becker WC, DeBar LL, Heapy AA, Higgins D, Krein SL, Lisi A, Makris UE, Allen KD. A research agenda for advancing non-pharmacological management of chronic musculoskeletal pain: findings from a VHA state-of-the-art conference. J Gen实习医生. 2018年5月,33(1):11 - 15号. doi: 10.1007/s11-6. PubMed