The "Chronic Care Model" (CCM), developed by Edward H. Wagner, represents a watershed attempt to address the disconnect between acute models of care and those oriented toward chronic patients for whom lifestyle changes rooted in everyday life are a central concern. To achieve the system-wide changes needed to advance the cause of patient self-care, the CCM focuses on synergizing various layers of the healthcare system, including clinical research and quality improvements, new communication technologies, and provider-patient interactions. Crucially, the conduits that connect these layers have received scant attention, especially when it comes to the methods of interaction and persuasion that enhance the prospects for healthcare innovation. This project addresses this gap drawing inspiration from Richard McKeon's claim that the art of rhetoric provides tools for synergizing complex and highly interactive human systems. Thus, it rhetorically re-imagines the CCM, arguing that rhetoric plays a role in cultivating better clinical practices through collaboration across the spectrum of activities that make up chronic care. To achieve this end, this project focuses on a CCM inspired case study: the Online Lifestyle Support System (OLSS), developed through a robust relationship between academic researchers and corporate disseminators. The OLSS translates an evidence-based lifestyle curriculum into an online platform designed to assist obese and diabetic patients in managing their weight and co-morbid conditions. This online system includes online lessons and live lifestyle coaching. In order to capture unique insights about the practices of lifestyle management within the OLSS, this dissertation draws on three interview projects with individuals working at each layer of chronic care delivery: lifestyle coaches, participants in the study, and those tasked with advertizing and selling the OLSS to new clinical environments. Drawing on the words of these different groups provides grist for the granular development of new insights into the practices that make-up chronic care. Finally, in framing these interview projects, this dissertation draws on rhetorically-inflected terms from the ancient Greek tradition: paideia (education), phronesis (experiential learning), and eudaimonia (the fulfilling life), to articulate the developmental and persuasive processes involved in the preparation of practitioners, the cultivation of self-care, and the effort to disseminate new research findings.
展开▼
机译：由爱德华·H·瓦格纳（Edward H. Wagner）开发的“慢性护理模型”（CCM）代表了一个分水岭，它试图解决急性护理模型与面向慢性病的人之间的脱节问题，这些人的生活方式根植于日常生活中。为了实现推进患者自我护理事业所需的全系统变化，CCM致力于使医疗保健系统的各个层面协同作用，包括临床研究和质量改进，新的通信技术以及医患之间的互动。至关重要的是，连接这些层的管道很少受到关注，尤其是在涉及相互作用和说服方法方面，这增强了医疗创新的前景。该项目解决了这一差距，这源于理查德·麦肯（Richard McKeon）的主张，即修辞艺术为融合复杂且高度互动的人类系统提供了工具。因此，它在修辞学上重新构想了CCM，认为修辞学通过在构成慢性病的各种活动中进行协作，在培养更好的临床实践中发挥了作用。为了实现这一目标，该项目专注于受CCM启发的案例研究：在线生活方式支持系统（OLSS），该系统是通过学术研究人员与企业传播者之间的牢固关系而开发的。 OLSS将基于证据的生活方式课程转换为在线平台，旨在帮助肥胖和糖尿病患者控制体重和合并病情。该在线系统包括在线课程和现场生活方式指导。为了获取有关OLSS中生活方式管理实践的独特见解，本论文借鉴了三个访谈项目，这些访谈项目涉及慢性病护理每一层的工作人员：生活方式教练，研究参与者以及负责广告宣传和销售的人OLSS适应新的临床环境。利用这些不同群体的话语，就可以为构成慢性病护理实践的新见解的精细发展提供依据。最后，在制定这些访谈项目的框架时，本文借鉴了古希腊传统的修辞学术语：花：病（教育），语调（体验式学习）和eudaimonia（充实的生活），以阐明参与其中的发展和说服过程从业人员的准备，自我保健的培养以及努力传播新的研究结果。
展开▼
