基于远程医疗的个案管理模式在老年慢性心力衰竭患者院外管理中的应用

目的 探讨基于远程医疗的个案管理护理模式在老年慢性心力衰竭患者院外管理中的应用效果，为创新保健服务管理模式提供参考。方法 采用随机抽样法选取中国人民解放军总医院第六医学中心干部心血管内科住院治疗的老年慢性心力衰竭患者120例作为研究对象，采用随机数字表法将其分为干预组和对照组，各60例，干预组实施基于远程医疗的个案管理护理模式，对照组实行常规随访指导。比较2组患者的生活质量、6 min步行距离、治疗依从性和再入院率。结果 2组患者生活质量评分和治疗依从性在干预前和干预后1个月无显著差别，干预后3个月、6个月、12个月干预组显著高于对照组(P<0.05)，干预时间越长，差异越显著。与对照组比较，干预组6 min步行距离远，再入院率低，差异比较具有统计学意义(P<0.05)。结论 基于远程医疗的个案管理模式用于老年慢性心力衰竭患者院外管理可以有效改善患者的生活质量，提高患者治疗依从性，降低再入院率，具有推广意义。

Application of case management model based on telemedicine in the management of elderly patients with chronic heart failure

Objective To explore the application effects of the nursing model of telemedicine-based case management in the elderly patients with chronic heart failure, so as to provide evidences for developing innovative models of healthcare service management. Methods A total of 120 elderly patients with chronic heart failure admitted to our department were randomly selected, and were assigned, using random number table, to the intervention group or control group each including 60 patients. The intervention group adopted the nursing model of telemedicine-based case management, while the control group received routine follow-up instructions. The two groups were compared for quality of life, 6-minute walk test result, treatment compliance, and readmission rate. Results Quality of life score and treatment compliance showed no significant differences between the two groups prior to or at 1 month of intervention, and were significantly higher in the intervention group than in the control group at 3 months, 6 months and 12 months of intervention, the differences increasing with the prolongation of intervention. The 6-minute walk test results were significantly higher, and the readmission rate was significantly lower in the intervention group than in the control group, with statistically significant differences (P<0.05). Conclusion For elderly patients with chronic heart failure, the nursing model of telemedicine-based case management could improve their quality of life and treatment compliance, and reduce the readmission rate, which supports further application.