Tara Sampalli, Robert Dickson, Jill Hayden, Lynn Edwards, Arun Salunkhe
{"title":"满足复杂人群的需求:以功能性健康和患者为中心的多病管理方法。","authors":"Tara Sampalli, Robert Dickson, Jill Hayden, Lynn Edwards, Arun Salunkhe","doi":"10.15256/joc.2016.6.83","DOIUrl":null,"url":null,"abstract":"<p><p>Individuals with multimorbidity have complex care needs along with significant impacts to their functional health and quality of life. Recent evidence-based and experience-based explorations have revealed the importance of patient perspectives and functional health management in improving care delivery and health outcomes for individuals with multimorbidity. The impact of managing multimorbidity is evident at multiple levels of healthcare - the individual, the provider, and the system. Our local experience dealing with these challenges has led to the development of a functional health model that includes patient perspectives in care delivery within the Integrated Chronic Care Service (ICCS) of the health authority in Nova Scotia. In this paper, we present a discussion of the challenges, guiding models, and service-level transformations that have been integrated into care delivery at the ICCS to meet the healthcare needs of people with multiple health conditions. We describe our redesign strategies for care team planning, treatment approach, and patient inclusion.</p>","PeriodicalId":92071,"journal":{"name":"Journal of comorbidity","volume":"6 2","pages":"76-84"},"PeriodicalIF":0.0000,"publicationDate":"2016-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15256/joc.2016.6.83","citationCount":"10","resultStr":"{\"title\":\"Meeting the needs of a complex population: a functional health- and patient-centered approach to managing multimorbidity.\",\"authors\":\"Tara Sampalli, Robert Dickson, Jill Hayden, Lynn Edwards, Arun Salunkhe\",\"doi\":\"10.15256/joc.2016.6.83\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Individuals with multimorbidity have complex care needs along with significant impacts to their functional health and quality of life. Recent evidence-based and experience-based explorations have revealed the importance of patient perspectives and functional health management in improving care delivery and health outcomes for individuals with multimorbidity. The impact of managing multimorbidity is evident at multiple levels of healthcare - the individual, the provider, and the system. Our local experience dealing with these challenges has led to the development of a functional health model that includes patient perspectives in care delivery within the Integrated Chronic Care Service (ICCS) of the health authority in Nova Scotia. In this paper, we present a discussion of the challenges, guiding models, and service-level transformations that have been integrated into care delivery at the ICCS to meet the healthcare needs of people with multiple health conditions. We describe our redesign strategies for care team planning, treatment approach, and patient inclusion.</p>\",\"PeriodicalId\":92071,\"journal\":{\"name\":\"Journal of comorbidity\",\"volume\":\"6 2\",\"pages\":\"76-84\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2016-08-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.15256/joc.2016.6.83\",\"citationCount\":\"10\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of comorbidity\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15256/joc.2016.6.83\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2016/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of comorbidity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15256/joc.2016.6.83","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2016/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
Meeting the needs of a complex population: a functional health- and patient-centered approach to managing multimorbidity.
Individuals with multimorbidity have complex care needs along with significant impacts to their functional health and quality of life. Recent evidence-based and experience-based explorations have revealed the importance of patient perspectives and functional health management in improving care delivery and health outcomes for individuals with multimorbidity. The impact of managing multimorbidity is evident at multiple levels of healthcare - the individual, the provider, and the system. Our local experience dealing with these challenges has led to the development of a functional health model that includes patient perspectives in care delivery within the Integrated Chronic Care Service (ICCS) of the health authority in Nova Scotia. In this paper, we present a discussion of the challenges, guiding models, and service-level transformations that have been integrated into care delivery at the ICCS to meet the healthcare needs of people with multiple health conditions. We describe our redesign strategies for care team planning, treatment approach, and patient inclusion.