Research Triangle Patients Stratified Hierarchical Management Model In Discharge Hypertension

Objectives:To investigate and refer Triangle chronic hierarchical classification management model in effect discharge follow-up management of patients with hypertension;hypertensive patients discharged Comparison Triangle hierarchical classification standard management group and routine follow-up management group,in compliance behavior Compliance,aspects of medication compliance and self-management skills,such as management effectiveness differences.Triangle establish hierarchical classification management standards for discharged patients with hypertension,so that it can better efficient use of medical resources,to stratify patients with hypertension do not discharge,in order of priority treatment and management,and to promote their best to achieve at different levels good compliance behavior,medication behavior,self-management behavior;ultimately promote the effective control of hypertension patients and reduce complications,to get the best quality of life and social regression.Methods:This study was divided into two parts;the first part of discharged patients with hypertension Triangle hierarchical classification management standards of preparation.Reference 2002 large chronic care institutions in California Kaiser Permanente chronic Triangle hierarchical model,compiled in 2010 Liu Lisheng,etc."hypertension guidelines",literature,counseling and medical care in the province hypertensive disorders expert advice,the use of the Delphi method,the preparation of discharged patients with hypertension Triangle hierarchical classification management standards.Include two standards,Standard:hypertensive patients discharged Triangle stratification criteria,standard two:the hospital management standard classification of hypertension patients.The second part is randomized controlled trial design;select First Affiliated Hospital of Guangxi Medical University,diagnosed with hypertension ward 200 patients with essential hypertension,the application randomly grouped control group 100 cases,according to the clinical care of patients with hypertension routine discharge follow-up;the intervention group of 100 patients before discharge applications Triangle stratified hierarchical classification criteria,divided into three layers(layers of high-risk,medium risk level and smooth layer);after discharge patients according to different levels,with reference to Triangle rating management standards for discharge follow-up management.Observation discharged hypertensive patients before discharge,after discharge compliance behavior 1,3,6 months,blood pressure,weight,BMI,waist circumference,blood pressure gauges,Morisiky medication self-management scale adherence scale and hypertension scores,the number of outpatient visits after discharge,and three months,and six months after lipids,HbA1c,FPG,Scr,UA and six months of high blood pressure,urgent care visits hypertension caused by high blood pressure the number of incidents of hospitalization,length of hospital stay.Data using SPSS 16.0 statistical software package for statistical analysis,the results of p<0.05 was considered statistically significant.Results:100 patients enrolled in the intervention group,excluding the seven cases,the remaining 93;control group,100 cases,12 cases excluded,the remaining 88;intervention group stratification Results:13 patients with high-risk level,there are 37 cases of intermediate risk,stable 43 Example;after the intervention in January,13 cases of high-risk,medium risk in 38 cases,42 cases of stable.After January 1 case of intervention into a smooth layer of medium risk level.Intervention in March after 12 cases of high-risk level,the risk level in 36 cases,45 cases of stable layer;intermediate risk into the high-risk one case,the risk transferred smoothly in 2 cases.Intervention in June after 10 cases of high-risk level,the risk level in 34 cases,49 cases of stable layer;high risk of entering the danger level in one case,the crisis has entered a stable layer 2 cases.There are three cases to enter the high-risk level in the risk level,a total of six cases of intermediate risk level into the stationary layer.The control group and the intervention group patients SBP(151.1 � 13.17vsl35.52 �7.79;F = 29.95 p = 0.00),DBP(89.44 � 12.5vs81.04 � 8.4;F = 4.51 p = 0.04),FPG(5.37 � 1.96 vs4.94 � 1.03;F = 4.97 p = 0.03),TG(1.29 � 0.59vs4.09 �0.64;F = 4.48 p = 0.04),TC(4.52 � 0.74vs4.09 � 0.64;F = 4.8 p = 0.03),the past six months the number of hypertensive outpatients(2.42 � 0.8vs4.84 � 0.45;t =-24.93 p ? 0.00)and hypertension-related emergency department visits(0.49� 0.55vs0.03 � 0.18;t = 7.47 p = 0.00),hypertension hospitalizations(0.98�0.73vs0.63�0.53;t = 3.65 p = 0.00),hypertension,average length of stay(5.93�4.22vs3.06 � 2.61;t = 5.46 p = 0.00)and hypertension compliance Medical behavior scale score(100.9 � 7.5vs113.71�8.06;F = 22.15 p = 0.00),Morisiky medication compliance and good level of compliance scale poor(35vs53:53vs40;x2 = 5.36 p = 0.02)and high Blood pressure self-management skills scale(95.52 � 9.77vs106.59 � 6.45;F = 35.97 p = 0.00)between the two groups p<0.05,the difference was statistically significant.Conclusions:1?through the Delphi discharged Triangle hypertensive patients stratified grading standards effective and feasible.2?Triangle hierarchical classification of hypertensive patients discharged from hospital follow-up management of hypertension relative to conventional discharge follow-up of more effective management at different levels.2.1 Triangle hierarchical classification management group than in the conventional group stable in blood pressure control2.2 Triangle hierarchical classification management group test results than the conventional group on good cholesterol and other biochemical indicators of blood pressure2.3 Triangle hierarchical classification management group of hypertensive patients discharged in compliance treatment adherence behavior,medication adherence and self-management behavior good performance than the conventional group.