264343 Model for effective non-communicable diseases prevention and care: “Total Care Cycle”

Monday, October 29, 2012

Jiawen Zhou, MD , Gobal health Department, Project HOPE, Shanghai, China
Lily Hsu, RN, MSN , Gobal health Department, Project HOPE, Shanghai, China
Jiali Zhang, MD , Gobal health Department, Project HOPE, Shanghai, China
Qian Geng, MPH , Gobal health Department, Project HOPE, Millwood, VA
Katie Kowalski, MPH , Gobal health Department, Project HOPE, Millwood, VA
Yi Wu, MD , Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
Background To respond to the emerging needs of NCDs in China, Project HOPE launched a 3-year program in 2009 to improve the accessibility and quality of care for people with NCDs in 4 Chinese cities. The post-stroke rehabilitation sub-program effectively reached and improved the lives of patients in community settings.

Method: Developed a “Total Care Cycle” model which emphasizes continuity of care from the acute to post-discharge phases and involves a broad spectrum of stakeholders including health professionals, community members (CHWs), patients and family members. Using a community based participatory method, the post-stroke rehabilitation sub-program conducted trainings for CHWs on how to provide home-based rehabilitation and trainings for patients and families on disease self-management and home-based rehabilitation. Results: The sub-program established a post-stroke rehabilitation network of 6 tertiary hospitals, 4 secondary hospitals and 14 community centers focused on building capacity at community health centers, benefiting patients and strengthening the health system. 634 stroke patients completed the 5-month home-based rehabilitation intervention. 53.8% of participants improved upper limb function, 37.5% improved hand function and 49.5% improved lower limb function. Their average scores on the “Activity of Daily Life” index increased by 76.5%.

Recommendation and Implication: Low-cost community based interventions have high impact on quality of life and ease the NCD burden on the health system. Multi-sectoral cooperation and community mobilization are key elements in the “Total Care Cycle” approach to reducing the negative impact of NCDs.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
•Demonstrate how low-cost community-based interventions can improve the lives of people suffering from chronic diseases. •Develop a” Total Care Cycle” model to address chronic diseases. •Identify ways to enhance stroke rehabilitation for patients in the community.

Keywords: Chronic Diseases, Strokes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-principal of international health care program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.