The Application Study Of Case Management Mode For Elderly Patients With Hypertension

ObjectivesTo evaluate the case management model for the elderly patients with hypertension on the cost of medical treatment,encluded the hospitalization expenditure,hospitalization date,the readmission rate;and the quality of care,exluded the blood pressure value,BMI,quality of survival,medication adherence of self,patients’satisfaction and the influence of psychological Emotional.Analysis and evaluation of this model to promote the nurse practice of the elderly hypertension,provide the clinical refence basis for the effctive for the hospital to develop chronic disease management model for elderly.MethodsWe randomized chose 90 hypertension patients who were at age of sixty or over in geriatric department of a top-level hospital in Hunan Province during the period from January to July 2017.Then these patients were randomly divided into experimental group(45 cases)and the control group(45 cases)according to the random number table.Both groups were the regular hypertension treatment and nursing management.The experimental group on the basis of the implementation of case management care intervention 6 moths.There were six steps to implement case management points,namely assessment,planning implementation,coordination,feedback and evaluation.In this study,the general conditions and baseline data of patients were investigated with the qustionnaire at the time of admission,evaluated the hospitalization days,the hospitalization spending and the patient satisfaction at the time of discharge,after intervention in 3 months and 6 months the blood pressure value、body mass index were used for evaluation,WHOQOL-BREF was used to investigate the quality of life,Intervention before and after intervention in 6 months "Hospital Anxiety and Depression Scale"、"Morsiky from questionnaire"and self-designed questionnaire were used to evaluation social psychological、treatment compliance assessment.We appraised the numerber of hospitalizations during 6 months after discharge.All date were analyzed by the statistical software Spss23.0 and the statistical methods including statistical description,Chi-square test,Nonparametric Test,T-test and repeated measures ANOVA.Results1.Baseline comparison According to the test,there was no statistical difference between the two groups of the general data and in term of baseline outcome variables.The study data of the two groups were comparable.2.there was no significant differences in hospitalized spending and hospitalization days after intervention((P>0.05),but significant differences was found in number of hospitalizations during 6 months after discharge(P<0.05).3.Comparison of intra-group after intervention Groups Comparison Systolic blood pressure,diastolic blood pressure,body mass index and quality of life of the experimental group were statistical significance,(P<0.05);Winthin the control group were statistical significance too,(P<0.05),4.Comparison between groups after intervention4.1 The day before discharge There was statistical significance in patient satisfaction between two groups at the time of hosipitalization,(P<0.05).4.2 After 3 months intervention There was no statistical significance in the physiological dimension of quality of life between the two groups,(P>0.05).There were statistical significance in systolic blood pressure,diastolic blood pressure,PSYCH,SOCIL and ENVIR,(P<0.05).4.3 After 6 months intervention,There were statistical significance in all kinds of fields at quality of life except for the PHYS between two groups,the experimental group systolic pressure,diastolic blood pressure,body mass index,psychological field,PSYCH,SOCIL、ENVIR、patient satisfaction,medication adherence and non-drug treatment compliance compared with control group,with statistical significance(P<0.05).Conclusions1.The Case management may has the tendency to shorten the average hospitalization days,reduce hospitalization costs and significantly reduce the readmission rate of the elderly hypertensive patients,reduce medical costs.2.The Case management may reduce and control blood pressure and BMI of the elderly hypertensive patients.3.The Case management may improve the quality of life and the self-management behavior of the elderly hypertensive patients.4.The Case management may improve the patients’ satisfaction of the elderly hypertensive patients.