| ObjectiveBased on understanding the current status of chronic wound management practices in the specialist alliance,and the issues and specific needs faced by various stakeholders,a chronic wound management model based on the specialist alliance is constructed,and then its initial results are run and evaluated.Methods1.Based on the literature review,self-made questionnaires were used to conduct questionnaire surveys on patients with chronic wounds,managers of member units of specialist alliances,and nurses engaged in wound care using convenient sampling methods,purpose sampling methods,and stratified random sampling methods.2.Using the objective sampling method and applying the outline of interviews of personnel at different levels established through pre-interviews,semi-structured interviews were conducted with patientswith chronic wounds treated in the specialist alliance,managers of member units of the alliance,and nurses engaged in chronic wound care in the alliance.3.Based on the policy analysis method,literature data method,and survey results,combined with the expert group meeting method,a chronic wound management model based on the specialist alliance was established,and then the initial effectiveness of the model was evaluated after operation.Results:1.Quantitative research results: A total of 800 chronic wound patients,65 managers,and 300 nurses participated in the survey.(1)39.5% of patients choose a tertiary hospital for treatment,and 60.5% choose a primary hospital;for patients of different ages,family per capital monthly income,medical expenses payment method,place of residence,course of disease,and ability to take care of themselves,they choose different hospitals(P<0.01).The main reasons for choosing a tertiary hospital for treatment are high medical standards,professional wound therapists and wound products.The main reasons for choosing a primary hospital are the high proportion of medical insurance reimbursement and the convenience of being nearby.90.3% of patients have health service needs for primary hospitals.(2)Only about 30.0% of hospitals have open wound specialist clinics with wound specialist nurses and wound products.96.9% ofmanagers believe that it is necessary to build a chronic wound management model.Their main needs are: access to expert on-site guidance,regular training,remote consultation,etc..(3)57.9% of the nurses engaged in wound care have not obtained a wound care qualification certificate,95.0%are part-time,but more than 90% are interested in wound care work.In terms of follow-up training,74.6% of nurses stated that their knowledge of chronic wounds had not been updated in the past year,and more than 50%of nurses did not understand the performance and choice of new dressings and the theory of wet healing.2.Qualitative research results: 10 chronic wound patients,6 managers and 8 nurses participated in the interview.(1)Patients with chronic wounds believe that the level of professionalization of wound management in primary hospitals is low.The main needs are standardized wound care,access to health resources,basic life care and health education,and psychological support.(2)The members of the alliance stated that their software,hardware,and human resources were inadequate,and they lacked an information sharing platform.Their main needs include professional technical support,up-down linkage,information connection,chain-based continuing education and training,and wound clinics and scientific research guidance.(3)The interviewed nurses said that in the process of wound care,there will be three kinds of experiences and feelings of sadness and weakness,responsibility and mission,growth and harvest;the mainproblems they face include incomplete normative guidance,insufficient resource support and their own knowledge Insufficient reserves and few training opportunities;its main needs are to build a chronic wound training system within the alliance and build an information exchange platform.3.Construction results: A chronic wound management model based on a specialist alliance was established,including a macro model of the model,a basic content framework,and a specific service operation model for patients with chronic wounds.4.Operating results: The model has been running for 10 months,and has provided on-site technical guidance to 5 alliance member hospitals for more than 10 times,conducted remote consultations 102 times,on-site consultations 6 times,online teaching 6 times,and received 23 fellowships to train WOCN 57 people waited.Compared with before the implementation of the model,the average economic cost and time cost of patients with chronic wounds decreased(P <0.001),and patient satisfaction increased(P <0.001).Conclusion1.The core unit of the specialist alliance should choose appropriate methods to assist member units and provide diversified service content to meet the multi-level needs of different stakeholders for this model.2.Under this model,a service operation process with clear responsibilities and mutual collaboration can be provided to provide overallmanagement measures for patients with chronic wounds.3.The chronic wound management model based on the specialist alliance has initially achieved certain results.This model reduces the cost of medical treatment and improves the sense of medical treatment;it is conducive to the continuous diagnosis and treatment of patients with chronic wounds and improves patient satisfaction. |
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