健康发展与政策研究2025，Vol.28Issue(5)：501-508,516,9.DOI:10.12458/HDPR.202407101
慢性病共病整合管理理论模型的研究进展与启示
Research progress and implications of theoretical models for integrated management of chronic multimorbidity
摘要
Abstract
Objective To analyze existing theoretical models for the integrated management of chronic multimorbidity,providing a basis for constructing an integrated healthcare model for chronic multimorbidity in China.Methods This study performed a systematical literature review on theoretical models for the integrated management of chronic multimorbidity from CNKI,Wanfang,PubMed,Embase,and Web of Science.The search period covered from the inception of each database up to January 23,2024.The retrieved literature was then screened and extracted.Results A total of eleven articles were included.Based on the complexity and heterogeneity of chronic multimorbidity,the study identified three common principles:patient-centeredness,continuity and coordination of services,and the emphasis on clinical guideline support and evidence-based practice.Seven core components were summarized:health service delivery,leadership and governance,human resources,financing and incentives,technology support and medical products,data collection and application,and monitoring and management.Conclusion Existing theoretical models for integrated chronic multimorbidity management focus on common modules,emphasize the micro-level,and require dynamic adaptation due to different scenarios.For China,it is recommended to prioritize the development of evidence-based multimorbidity guidelines,strengthen community workforce management,enhance the construction of close-knit medical consortia,leverage the power of technological innovation,and explore innovative payment mechanisms.关键词
慢性病/慢性病共病/慢性病管理/健康管理/文献综述Key words
chronic disease/multimorbidity/chronic disease management/health management/literature review分类
预防医学引用本文复制引用
王宝悦,王盛,李祥龙,丁思雨,周萍..慢性病共病整合管理理论模型的研究进展与启示[J].健康发展与政策研究,2025,28(5):501-508,516,9.基金项目
上海市政府决策咨询研究重大课题项目(2023-A-28-A) （2023-A-28-A）
上海市卫生健康委员会卫生健康政策研究课题(2023HP87) （2023HP87）
