Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo)

Abstract

PurposeProject Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM) model and of the introduction of “care manager” nurses, trained in this specialized role, into the primary health care system.Patients and methodsThirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative “team” consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD), diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk) to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization.ResultsResults show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services as well as treatment paths helped promote confidence and enhance safety of chronic patient management at home.ConclusionPhysicians, care managers, and patients showed unanimous agreement regarding the positive impact on patient health and self-management, and attributed the outcomes to the strong “partnership” between the care manager and the patient and the collaboration between the physician and the care manager. Future studies should consider the possibility of incorporating a patient empowerment model which considers the patient as the most important member of the health team and care managers as key health care collaborators able to enhance and support services to patients provided by physicians in the primary health care system.

Effect of SpineCor Dynamic Brace Treatment on the Result of Surgical Correction of Adolescent Idiopathic Scoliosis

“…The control group (Group B) comprised 46 patients (44 girls and 2 boys), with a mean age at the time of the surgery of 15.2 ± 1.6 years (ages [11][12][13][14][15][16][17][18][19]) and the mean magnitude of the Cobb angle before surgery was 68° ± 14° (46°-101°). In this group, the most prevalent curves were double primary curves (41% of patients) and thoracic primary curves (41% of patients).…”

“…However the authors want emphasize the importance of cooperation between the entire team of specialists in the treatment of idiopathic scoliosis, in particular physiotherapists and orthopedists, at such a critical moment when the decision of conducting a surgery must be made. Ciccone et al [18] report that a strong cooperative team is significant during the treatment. In this study (Project Leonardo) physicians, care managers and patients demonstrated unanimous agreement concerning the positive impact on patient health and self-management.…”

“…In this study (Project Leonardo) physicians, care managers and patients demonstrated unanimous agreement concerning the positive impact on patient health and self-management. They also attributed the outcomes to the strong collaboration between all team members and between the physicians and the patients [18]. Such unanimity of all orthopedics specialists is also crucial.…”

Handling of Household Flammables by Elderly Dwelling in the Community: General Survey on Actual Status; The Kurihara Project

“…Daily cooking is also essential for health. Care managers should manage both the residents' nutrition for health and cooking environment, with cooperation of other health personnel [5].…”

Demographic Characteristics and Sense of Danger Predicting New Measure of Individual Resilience Following a War

“…For example, Ciccone et al [25] have presented Project Leonardo which examined the Chronic Care Model developed by Wagner et al [26] based on partnership between the patient and health professionals. This model offers the opportunity to empower patients to become more active in managing their health.…”