Chronic conditions demand “chronic” interventions intended for their holistic and thorough management, which is definitely embraced in the so-called chronic care model (CCM) [1]. In chronic obstructive pulmonary disease (COPD), an increasing body of evidence stresses the need for this patient-focused approach to care [2]. Since its first application, the chronic care method has needed to identify the ideal subset of patients that would largely benefit from its practice in real life and the most impactful areas of intervention. Recovery from hospitalisation following admission due to acute exacerbations is often recognised as the ideal time during which to educate the patient on how to react to health deterioration. Indeed, the transition from hospital back to the community represents a critical process, failure of which is associated with higher rates of rehospitalisation [3]. A chronic care model in primary care is feasible and effective for the COPD population even at an early stage http://ow.ly/yZzR30gE26r

中文翻译：

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在 COPD 患者中寻找慢性护理模式

慢性病需要“慢性”干预，旨在对其进行全面和彻底的管理，这在所谓的慢性病护理模式 (CCM) [1] 中得到了肯定。在慢性阻塞性肺疾病 (COPD) 中，越来越多的证据强调需要这种以患者为中心的护理方法 [2]。自首次应用以来，慢性病护理方法需要确定理想的患者子集，这些患者将在很大程度上受益于其在现实生活中的实践和最有影响力的干预领域。因急性加重入院后从住院中恢复通常被认为是教育患者如何应对健康恶化的理想时间。事实上，从医院到社区的过渡是一个关键的过程，其失败与更高的再住院率有关 [3]。即使在早期阶段，初级保健中的慢性护理模式对 COPD 人群也是可行和有效的 http://ow.ly/yZzR30gE26r