RESUMEN
OBJECTIVE: To explore the impact of routine management compared to case management on social support and self-efficacy of patients with chronic diseases and assess the new nurse-led healthcare collaborative model. METHODS: This is a prospective study which was approved by the Biomedical Ethics Committee of Anhui Medical University. A total of 100 patients with chronic diseases who received treatment and care in Hefei First People's Hospital from January 2020 to December 2021 were selected as the study subjects and divided into a control group and an observation group according to the numerical table method, with 50 cases in each group. In the control group, conventional management was implemented, while the observation received a nurse-led healthcare collaborative care, which included community doctors providing treatment services and family doctors contracting to manage care. The patients in the two groups were compared in terms of self-efficacy, self-management ability, social support, and their attendance. RESULTS: Before the intervention, there was no statistically significant difference in self-efficacy, compliance and quality of life scores between the two groups (P>0.05). After the intervention, self-efficacy, compliance and quality of life scores were significantly higher in the observation group than those in the control group, with statistically significant differences (P<0.05). A statistical assessment of the transfer of patients from the community to the hospital was also conducted for both groups, and it was found that the proportion of patients transferred from the community to the hospital was significantly higher in the observation group compared to that in the control group after surgery, with statistically significant differences in hospital costs, hospital days and readmission rates between the two groups (P<0.05). The proportion of patients transferred from the hospital to nursing home increased by 72.2% in the observation group compared to only 35.5% in the control group, and the discharge rate (home care) was significantly higher in the observation group (P<0.05). CONCLUSION: This study provides some references for the effective management of patients with chronic diseases. By comparing the data from the conventional and case care management models, it can be found that the use of a nurse-led healthcare collaborative model meets the acute medical and nursing service needs of older people, improves timely access to medical and nursing resources, and effectively improves self-efficacy, compliance and quality of life in patients with chronic diseases.