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Achievement of appropriate self-care. Does care delivery system make a difference?

OBJECTIVES
The purpose of this article is to review the evidence linking variations in care delivery system with achievement of appropriate self-care.


METHODS
This synthetic review of the research literature used the Outcomes Model for Health Care Research. The concept of self-care was reviewed from several theoretical perspectives, as was the quality of instruments used to measure aspects of self-care. Finally, studies examining the linkage between care delivery system and self-care were critically analyzed.


RESULTS
Reliable and valid instruments exist to measure self-care agency and self-care performance, and these data elements are collected routinely in many care settings. Only a few studies, however, have examined the relation between achievement of self-care and variations in delivery systems.


CONCLUSIONS
Achievement of appropriate self-care may be an outcome measure better suited to nonacute care settings or across the continuum of care. Additionally, work is needed in applying risk-adjustment strategies to the measurement of achievement of appropriate self-care.