The Role of Nursing in Disease Management


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The Role of Nursing in Disease Management. Weber P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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The Role of Nursing in Disease Management

  1. 1. Disease Management Nursing
  2. 2. What’s disease management Effectiveness Preventive and curative interventions Efficiency Increase the quality of care Reduce the global cost Promoting patient or family self management
  3. 3. Health care environement • GPs care for and encourage patient to join disease management program. • Nurses, physical therapist, nutritionist, physical trainer, social worker and other care takers • Patient and family have the key role
  4. 4. Success of disease management • Reducing costs by • Prevention of complications • Reducing hospitalization or re-hospitalization • Reducing MD specialist encounters • Participation in HMOs or managed care • Increasing the effectiveness, efficiency • Following best practice • Education and training
  5. 5. Hospitals are also concerned • Not only when the patient is discharge • During hospital stays: • Critical pathways • Evidence based • Nurses are best positioned to manage the stay and prepare the discharge. • Coordinate care after discharge from multi- discipline team
  6. 6. Nurses’ roles • Caring and prevention • Coordination across the health care provider team • Do patient and family education • Conduct research • Contribute to evidence based
  7. 7. Nurses’ roles • In Gonseth et al. study, nurses play a key role in the follow up for patient with heart failure or cardiovascular causes • In the 27 studies screened 18 reported that nurses played a central role in the disease management • 30% reduction of re-hospitalization over 3160 patients
  8. 8. Training • For patient education, nurses need competencies in: • Evidence based • Clinical research • Prevention • Psychosocial aspects • PHR structure and goals • EHR structure and goals
  9. 9. Role of IT • Personal health record allows the patient to: • Self monitor • Communicate • Record • Empower decision
  10. 10. Thank you Questions
  11. 11. References • Gaspoz JM. Rutschmann O Faut-il avoir peur du disease management 1 Volet hopistalier Revue médicale Suisse. accessed 30.01.2010 • Goldstein P. Impact on disease management programs on hospital and community nursing Practice. CNE series. Nursing Economics (Nov-Dec) 2006 vol. 24 no 6 pp 308- 313 • Gonseth J. Guallar-Castillon P, Banegas J.R, Rodrıguez-Artalejo F, The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Elsevier Ltd European Heart Journal (2004) 25, 1570–1595 • Fletley Brennan P. Promotion Health through better Personal Health Information Management. HIMSS Atlanta March 2010 • Rutschmann O. Gaspoz JM. Faut-il avoir peur du disease management 2 Volet ambulatoire Revue médicale Suisse. accessed 30.01.2010 • Vinne van der E. The ultimate goal of disease management: improved quality of life by patient centric care. International Journal of Integrated Care – Vol. 9, 10 August 2009 – ISSN 1568-4156 – accessed 30.01.2010