| ObjectiveThe study aimed to evaluate the effects of case management on self-management efficiency,fistula function,medical costs and nursing service satisfaction of hemodialysis patients with arteriovenous fistula.Methods1.Quasi-experimental study:the selected patients were divided into intervention group and control group according to their different dialysis districts of the same hospital and conducted a one-year research survey.The patients in the control group were given routine nursing,and the patients in the intervention group received case management that guided by the Donabedian management model.It mainly included structural intervention:selected case managers,established the professional case management platform,formated case management team,implemented the responsible care model,perfected the shift system of autogenous arteriovenous fistula.Process intervention:established personal file,planned puncture poins in tultrasound-guided,detailed monitoring and daily maintenance.Outcome intervention:summarized and reflected on the problems existing in patient management,discussed the options for improving results,and optimized the structure intervention and process intervention.2.Changes in patient self-management efficacy,draining vein blood flow and diameter and dialysis adequacy were measured before intervention and 3,6 and 12 months after admission.The primary and secondary patency rates of 3,6 and 12 months were compared between the two groups.The length of hospital stay and the cost of medical treatment in two groups were compared.The changes of nursing service satisfaction before and after intervention were compared between the two groups.3.SPSS21.0 was employed for statistical analysis of the data.Statistical description was adopted by frequency and constituent ratio.About statistical analysis,we analyzed qualitative data by chi-square test and quantitative data by two independent sample T test,non-parametric test,repeated measurement analysis of variance and etc.The test level was specified as α=0.05.ResultsIn this study,160 patients were investigated,3 patients were lost,included 2 patients in the intervention group and 1 patient in the control group.In the end,a total of 157 patients were effectively treated,included 78 in the intervention group and 77 in the control group.1.There were no statistical significant difference between the two groups in the baseline datas included general information data,self-management efficacy scores,draining vein blood flow and diameter,Kt/V value,and nursing satisfaction(P>0.05).2.Comparison of self-management efficacy scores between two groups:the time effect of diet behavior(F=699.823,P<0.01),treatment behavior(F=349.744,P<0.01),somatic activity(F=237.439,P<0.01)and total self-management scores(F=478.376,P<0.01)were statistically significant.The intervention effect of diet behavior(F=10.474,P<0.01),treatment behavior(F=20.244,P<0.01),somatic activity(F=19.120,P<0.01)and total self-management scores(F=16.218,P<0.01)were statistically significant.There were correlations between the time and intervention effect of diet behavior(F=104.377,P<0.01),treatment behavior(F=160.433,P<0.01),somatic activity(F=175.725,P<0.01)and total self-management scores(F=174.412,P<0.01).3.Comparison of draining vein blood flow between two groups:the results showed that the time effect was statistically significant(F=23.978,P<0.01),the intervention effect was statistically significant(F=3.990,P<0.05),there was a correlation between the time and intervention effect(F=3.423,P<0.01).4.Comparison of draining vein diameter between two groups:the results showed that the time effect was statistically significant(F=23.658,P<0.01),the intervention effect was statistically significant(F=4.103,P<0.05),there was a correlation between the time and intervention effect(F=11.373,P<0.01).5.Comparison of Kt/V value between two groups:the results showed that the time effect was statistically significant(F=18.485,P<0.01),the intervention effect was statistically significant(F=4.115,P<0.05),there was a correlation between the time and intervention effect(F=8.145,P<0.01).6.Comparison of patency of autogenous arteriovenous fistula between two groups:compared with the control group,the primary patency rate and secondary patency rate in the intervention group were higher at 3 months,6 months and 12 months,but there were no significant differences at 3 months and 6 months(P>0.05),there were significant differences at 12 months(P<0.05).7.Comparison of length of stay and medical costs between two groups:the hospitalization time of the intervention group was significantly less than that of the control group(Z=-2.216,P<0.05).The related medical expenses in the intervention group were significantly lower than those in the control group(Z=-1.991,P<0.05).8.Comparison of nursing satisfaction score between two groups:the average nursing satisfaction score of the control group before intervention was higher than that of the intervention group,but there was no statistical difference(t=1.789,P=0.075).After intervention,the mean score of intervention group was higher than that of control group,and there was statistical difference(t=-7.720,P<0.001).ConclusionsThe nurse-led case management can improve patients’ self-management efficiency and the function of fistula.It also can increase the patency rate of fistula,reduce the medical cost of complications of fistula and improve the patient’s nursing satisfaction. |
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