摘要
目的探讨“一云三端”闭环式监管对慢性阻塞性肺疾病(COPD)患者的管理及其成效。方法选取2021年7月至2022年1月南京市第一医院收治的COPD患者96例,针对新型冠状病毒肺炎背景下COPD患者的诊疗特点和管理需求建立“一云三端”闭环式监管,从患者端、医疗机构端和运营端分别构建实施方案,2021年10月至2022年1月实施“一云三端”闭环式监管。随访管理过程中失访2例,其中变更就医地点1例,急性加重1例,失访者资料不纳入最终统计分析数据。比较干预前后临床指标[包括用力1秒呼气量(FEV1)、FEV1/用力肺活量(FVC)、COPD评估测试(CAT)和呼吸困难等级(mMRC)]、大健康指标[包括抑郁症筛查量表(PHQ-9)、广泛性焦虑量表(GAD-7)、6 min步行试验(6MWT)、morisky患者吸入用药依从性(MMAS-8)、戒烟率和疾病知晓率]、行为执行率(包括认知增加、心情舒缓、外出锻炼、用药打卡和医患沟通)等。结果94例患者干预后FEV1[(2.04±0.59)%]、FEV1/FVC[(69.12±5.14)]、MMAS-8得分[(6.96±0.27)分]、戒烟率[70.21%(66/94)]、疾病知晓率[51.06%(48/94)]均明显高于干预前[分别为(1.26±0.81)%、(51.39±17.76)、(2.10±0.44)、15.62%(15/96)、20.83%(20/96)],CAT评分[(8.41±6.87)分]、mMRC[(1.24±1.06)级]、PHQ-9评分[(2.37±1.56)分]、GAD-7评分[(2.39±1.69)分]均明显低于干预前[分别为(14.53±9.46)分、(2.13±1.14)级、(6.68±2.53)分、(5.97±1.88)分],差异均有统计学意义(P<0.05);干预后6MWT[(470.45±67.68)m]与干预前[(397.46±63.22)m]比较,差异无统计学意义(P>0.05)。行为执行率改善最多者为医患沟通(233.25%),最少者为外出锻炼(57.83%)。结论“一云三端”闭环式监管优化了患者端临床路径,患者从中获得多元化健康,平台重点围绕监测预警、行为干预和激励驱动三方面改善患者依从性,在一定程度上弥补了慢性病管理连续性的空缺。但患者独立性、适应性和灵活性仍存在管理难�
Objective To explore the supervision and effect of“one cloud three terminals”closed-loop on the patients with chronic obstructive pulmonary disease(COPD).Methods Ninety-six patients with COPD admitted to the Nanjing First Hospital from July 2021 to January 2022 were selected.According to the diagnosis and treatment characteristics and management needs of COPD patients under the background of COVID-19,the“one cloud and three ends”closed-loop supervision was established.The implementation scheme was constructed from the patient side,the medical institution side and the operation side.The“one cloud and three ends”closed-loop supervision was implemented from October 2021 to January 2022.In the follow-up management process,2 cases were lost to follow-up,including 1 case of changing the medical location and 1 case of acute exacerbation.The data of the lost to follow-up were not included in the final statistical analysis data.The clinical indicators before and after the intervention[including forced expiratory volume in 1 second(FEV1),FEV1/forced vital capacity(FVC),chronic obstructive pulmonary assessment test(CAT)and dyspnea rating(MMRC)],major health indicators[including depression screening scale(PHQ-9),generalized anxiety scale(GAD-7),6 min walk test(6MWT),Morisky patients′compliance with inhaled medication(MMAS-8),smoking cessation rate and disease awareness rate],behavior execution rate(including cognitive increase,mood relief,going out for exercise,medication punch in and doctor-patient communication).Results After the intervention,FEV1[(2.04±0.59)%],FEV1/FVC[(69.12±5.14)],MMAS-8[(6.96±0.27)points],smoking cessation rate[70.21%(66/94)],disease awareness rate[51.06%(48/94)]of 94 patients were significantly higher than those before the intervention[(1.26±0.81)%,(51.39±17.76),(2.10±0.44),15.63%(15/96),20.83%(20/96)],CAT[(8.41±6.87)points],mMRC[(1.24±1.06)grades],the scores of PHQ-9 depression scale[(2.37±1.56)points]and GAD-7 anxiety scale[(2.39±1.69)points]were significantly lower than thos
作者
卓佳星
龚伟伟
赵太宏
杨康
ZHUO Jiaxing;GONG Weiwei;ZHAO Taihong;YANG Kang(Affiliated Nanjing Hospital,Nanjing Medical University/Nanjing First Hospital,Nanjing,Jiangsu 210006,China;Affiliated Children’s Hospital of Nanjing Medical University,Nanjing,Jiangsu 210019,China)
出处
《重庆医学》
CAS
2022年第24期4218-4223,共6页
Chongqing medicine
基金
江苏省卫生健康委员会重点科研项目(ZDB2020012)。
关键词
慢性阻塞性肺疾病
慢性病管理
云平台
模式
chronic obstructive pulmonary disease
chronic disease management
cloud platform
mode
