案例管理从通才模式发展为以人为本的模式,与以人为中心的综合护理的最佳实践的循证演变相一致。病例管理是一种多维和协作的综合护理策略,其中病例经理执行一系列干预措施/行动,以支持具有复杂健康状况的人在恢复途径中取得进展并参与生活角色。目前尚不清楚什么案例管理模式在现实生活中对谁以及在什么情况下有效。这项研究的目的是回答这些问题。研究方法采用现实的评价框架,检查了案例管理器操作(机制)之间的模式和关联,人的特征和环境(上下文),严重损伤后10年以上的恢复(结果)。通过深入的回顾性文件审查(n=107)提取的数据采用混合方法进行二次分析。我们使用国际框架和多层分析的新方法,包括机器学习和专家指导进行模式识别。研究结果证实,如果提供,以人为中心的病例管理模式有助于并增强患者的康复和进展,以参与生活角色并在严重受伤后保持幸福感。此外,创伤性脑损伤患者的病例管理强度,以及以人为本的建议行动,情感和激励支持,积极的协调有助于实现他们的目标。研究结果为案例管理服务提供了案例管理模型的学习,进行质量鉴定,服务规划,并为病例管理的进一步研究提供信息。
Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative integrated care strategy where the case manager performs a set of interventions/actions to support the person with a complex health condition to progress in their recovery pathway and participate in life roles. It is currently unknown what case management model works in real life for whom and under what circumstances. The purpose of this study was to answer these questions. The study methods used realistic evaluation framework, examined the patterns and associations between case manager actions (mechanisms), the person\'s characteristics and environment (context), and recovery (outcomes) over 10 years post severe injury. There was mixed methods secondary analysis of data extracted via in-depth retrospective file reviews (n = 107). We used international frameworks and a novel approach with multi-layered analysis including machine learning and expert guidance for pattern identification. The study results confirm that when provided, a person-centred case management model contributes to and enhances the person\'s recovery and progress towards participation in life roles and maintaining well-being after severe injury.Furthermore, the intensity of case management for people with traumatic brain injury, and the person-centred actions of advising, emotional and motivational support, and proactive coordination contribute to the person achieving their goals. The results provide learnings for case management services on the case management models, for quality appraisal, service planning, and informs further research on case management.