Study On Construction Of A Model Of Continuity Of Cancer Care In Shanghai

Nowdays, cancer has been one of the most serious diseases threatening to human health. But because of the characteristic of carcinomas, cancer patients need to travel frequently to different hospitals and community agencies for cancer treatment, symptom management and palliative care. However, continuity of care is an effectiveness approach to improve their quality of lives. Meanwhile, continuity of care can ease the tension of relatively less hospital beds, reduce national health expenditure. Therefore, to develop continuity of cancer care in China has importment practical significance and far-reaching effects.This study aims to construct a basic, practical and systemic model of contintuity of cancer care in Shanghai.There are six parts in this study:In the first part we recalled the history of the development of continuity of care,defined the core concept of"continuity of care","model"and"continuity of cancer care model"and identified the continuity of"information","realtionship"and"care management"as the three core elements of the continuity of cancer care model.The second part is the literature research research on continuity of care services for cancer patients. Objective: finding out the basic situation of the continuity of care services for cancer patients at home and abroad to provide a theoretical basis for constructing the continuity of care model. Methods: Literature review on the continuity of care services for cancer patients at home and abroad.Results:①There had four continuity of care models and they were discharge planning model, the transitional care model, case management model and the mode of coordination of family doctors.②Continuity of cancer care was a process providing seamless care to cancer patients to link up hospital and community services.③The forms of continuity of care included professions of hospitals providing services to patients,professions of community agencies providing services to patients and services carried out jointly between hospitals and community agencies.④Professions of hospitals provided health counseling, health education and so on to discharged cancer patients. The community agencies developed disease surveillance, health education, service coordination for discharged patients. The hospitals and community ageicies construct the transfer of patients'information and some professional support services.The third part is an investigation of continuity of cancer care in Shanghai.Objective: Exploring the situation of the continuity of services for cancer patients in Shanghai, analysis the main problems and explores the influencing factors to provide a realistic basis for constructing a suitable and feasible model of continuity of cancer care. Methods: Continuity of care services was explored by field studies in 13 health services of different levels,17 care providers and 6 cancer patients were interviewed by semi-structure interviews .Results:①Parts of hospitals and community health service centers have developed and delivered some continuity of care servises for cancer patients more or less.But there were some problems existed, including the inadequate services of hospitals and communities, lacking of coordination between hospitals and community service centers, lacking of interaction between organizations.②Some care providers had realized the need of the development of continuity of care for cancer patients. The development of contintuity of cancer care were affected by so many factors from care providers,patiens and the policy input.③The patients existed needs of continuity of care,and their needs had different emphases.The forth part is the content analysis of discharge planning guidelines. Objective: Analyzing discharge planning guidelines to resolve the bottleneck problem of the continuity of services to cancer patients.Methods: The content analysis of discharge planning guidelines. Results:①Nine discharge planning guidelines were analyzed.②The two keys points of the joint of hospital and community services were timely contaction and information exchanges between care providers and the coordination between organizations.The fifth part is proposition of the model of continuity of cancer care in Shanghai. We construct the continuity of cancer care model for 10 main parts.The sisth part is the amendment of the basic model of continuity of cancer care in Shanghai. Objective: To amend and constitute the model of continuity of cancer care in Shanghai, which would provide sound guidance for improving cancer care service in the future.Methods: The continuity of care model based on the first part was amended and modified by expert panel and Delphi method (two rounds and 12experts).Results:①The results of expert panel: 12 experts joined the meeting. The basic model should be further defined"continuos mechanism"and"institution functions and services".The development of continuity of care for cancer patients needs the support of material and financial resources.②The results of Delphi method: the coefficient of authoritative (Ca) of the experts was 0.775. The response rates (RR) of the experts in the two rounds were both 100%.At lase we got the modified model of 9 Main parts.Conclusions:①Continuity of cancer care needs the coordination of hospital and community care and the core elements of continuity of care was to get the continuity of"information","raltionshiop"and"care management".②The forms of continuity of care included professions of hospitals providing services to patients,professions of community agencies providing services to patients and services carried out services jointly between hospitals and community agencies.③Parts of hospitals and community health service centers in Shanghai have developed and delivered some continuity of care servises for cancer patients more or less. But there were some problems existed and it was important to improve the services. For now, the most important issue is the connection between hospital and community services.④The connection between hospital and community services needs timely contaction and information exchanges between care providers and the coordination between organizations.⑤We construct a nine parts continuity of cancer care model,propose the service concept of"two tier platform"and the"continuos mechanism"of the service, standard the function of position and services.⑥Continuity of cancer care service should be improved through such aspects as professional training and government input.