The Spoke-Hub-and-Node Model of Integrated Heart Failure Care.

摘要: Heart failure (HF) is a significant public health concern. Specialized HF clinics provide the optimal environment to address complex needs of these patients and improve outcomes. The current growing population with outstrips ability deliver care. Integrated care defined as services that are managed delivered so people receive seamless continuum promotion, disease prevention, diagnosis, treatment, management, rehabilitation, palliative services. This approach requires coordination across different levels sites within beyond sector, according changing patient throughout their lives. spoke-hub-and-node (SHN) model represents an organization works collaboratively primary sector highly integrated community-based multidisciplinary teams professionals specialty purpose this article analyze requirements for successful implementation SHN models. We consider respective roles clinics, nurse specialists, pharmacists, teams, telemonitoring, solo practitioners. also discuss delivery importance stratification flow. has potential build on chronic (CCM) centralized preserve high-quality patient-centred at affordable costs.