个案管理模式在胃肠道肿瘤患者围手术期的应用与效果分析  

Effect analysis of case management in the perioperative period of patients with gastrointestinal tumor

作　　者：赵旻[1] 任晖[1] 李慧[1] 张洁[1] 杨红[2] 张悦[1] 张红[2] 陆宇晗[2] Zhao Min;Ren Hui;Li Hui;Zhang Jie;Yang Hong;Zhang Yue;Zhang Hong;Lu Yuhan(Department of Nursing,Beijing Cancer Hospital ＆ Beijing Institute for Cancer Research,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心,100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所护理部,100142

出　　处：《中国实用护理杂志》2018年第33期2620-2625,共6页Chinese Journal of Practical Nursing

摘　　要：目的探讨个案管理模式在胃肠道肿瘤患者围手术期的应用及效果。方法采用类试验研究设计，便利选取100例胃肠道肿瘤手术患者，按照入院时间分为对照组和干预组各50例。对照组10例失访，干预组4例失访，最终纳人86例患者。对照组接受围手术期常规护理，干预组接受围手术期常规护理＋个案管理模式干预。评价2组患者人院时、出院前日和术后5周的疾病不确定感；2组患者对诊疗过程的满意度；术后并发症发生率；首次复诊率。结果2组患者围手术期3个时间点（术前、出院前日和术后5周）疾病不确定感均处于中等水平，对照组分别为（103．38±14．94）、（109．58±16．06）、（113．90±15．95）分；干预组分别为（108．02±15．29）、（109．89±16．52）、（113．41±14．70）分；术后5周升高，组内纵向比较差异有统计学意义（F=14．117，P〈0．01）；干预组首次复诊率100．0％（46／146），较对照组的87．5％（35／40）高，差异有统计学意义（r=6．105，P〈0．05）；干预组患者对术前诊疗过程的满意度得分（14．41±1．13）分，高于对照组的（13．58±1．55）分，差异有统计学意义（t=-1．89，P〈0．01）；2组患者术后并发症的发生率差异无统计学意义（P〉0．05）。结论胃肠道肿瘤患者疾病的特殊性和治疗的复杂性给患者带来压力，个案管理模式作为一种全程连续照护模式，弥补了以往对患者的片段式管理的缺陷，有效提高了胃肠道肿瘤围手术期患者诊断期的就医体验和术后复诊率。Objective To investigate the effect of case management in the perioperative period of patients with gastrointestinal tumor. Methods The quasi-experiment study were took to design the research. A total of 100 patients were enrolled in this study. Patients were divided into control group （n= 50） and intervention group （n=50） by the admission time. The control group received routine nursing care, while the intervention group received routine perioperative care and case management during the perioperative period. The uncertainty of illness was compared between the two groups at the time point admission, on discharge and 5 weeks after surgery. The satisfaction during the process of treatment services, postoperative complications and return visit irate were compared too. After 5 weeks follow up, 10 cases in the control group and 4 cases in the intervention group were lost to follow-up, 86 cases were included in data analysis. Results Two groups patients all had medium uncertainty of illness at the three-different time points（preoptrative, l day before discharge and 5 weeks after surgery）. The scores of the control group were 103.38±14.94, 109.58±16.06 and 113.90±15.95 respectively.Those of the intervention patients were 108.02 ± 15.29,109.89 ± 16.52 and 113.41 ± 14.70.The uncertainty of illness elevated on the 5th week after surgery. Significant statistical differences were identified in the uncertainty of illness within each group （F=14.117, P〈0.01）. Significant statistical difference was identified in the visit rate, 100% （46/46）vs.87.5% （35/40） （X^2=6.105,P〈0.05）. The score of preoperative satisfaction of intervention patients （14.41 ± 1.13） was obviously higher than that of control patients （13.58±1.55） （t=- 1.89, P〈0.05）. Whereas, incidence of postoperative complications was not statistically significant between two groups. Conclusions The specificity of gastrointestinal tumor and the complexity of treatment bring about great pressure to patients. As the type o

关 键 词：个案管理 胃肠道肿瘤 疾病不确定感 依从性 

分 类 号：R473.73[医药卫生—护理学]