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Sun Xiao

Sun Xiao

Tongji University, China

Title: Healthcare outcomes about patients with chronic diseases: Measures and effect

Biography

Biography: Sun Xiao

Abstract

Background: In present, the incidence rates on chronic diseases increase every year across the world. The chronic diseases lead to physical / psychological injury and economic losses. So it is necessary to make effective measures to improve healthcare outcomes. Process: 10 healthcare groups of chronic diseases in the field of diabetes, stroke, peritoneal dialysis and others were established. The survey included KAP and demands investigation of patients/ family caregivers; intervention measures for improving healthcare outcomes, such as follow-up, health education, extended care and others. For example, diabetes nursing group had established: 1) health management system for recording blood glucose every time, for monitoring dynamically daily trends and average value; 2) health education turntable for providing standardization education of 5 to 10 minutes; 3) monitor network based on the mode of Hospital - Community - Patients; 4) E mode of diabetes management, that is: building archives-periodically measuring blood sugar-remote-monitoring-actively healthcare-providing health education. Stroke nursing group opened the outpatient clinics for screening risk factors when stroke happening, carried out various of health education methods (such as Micro Message Public Platform, rehabilitation App, etc), and instructed the post-strokes’ early rehabilitation exercise according to the standardized flowchart. Peritoneal dialysis nursing group developed the "health education prescription" and "Family Visit Form". Health education group built the “Community Health Education School”, and surveyed the community nurses on the training demand for theory knowledge and practice skills, investigate the chronic patients on the health education demand, the purpose of which were to build the operating model of community health education school including training classes and methods of community nurses, health education curriculum and education forms of chronic patients, etc. Results: Completion rate of follow-up reached to 63.5%. Percent of using insulin pen incorrect dropped from 61.7% to 12.5%. Complications related to stroke falling from 38.8% to 15.5%, readmission rate from 40% to 27.5%. Patients’ satisfaction was as high as 98%.We finished 50 times health education classes, 27 times community activities covering 5 districts and more than 3000 community residents came to join us. Awareness rate of health knowledge was more than 80%. Conclusion: Patients having chronic diseases received extended care, will effectively improve healthcare outcome including complication rates, readmission rates, awareness rates of health knowledge, health behavior compliance, etc.