摘要
研究背景
据WHO统计,2005年全球约3500万人死于慢性病,占全世界总死亡数的60%,预计到2020年将上升到70%。相当于感染性疾病、孕产和围产期疾患以及营养缺乏所致死亡总人数的两倍,其中80%发生在发展中国家。卫生部陈竺部长日前提出,如果没有有效的干预措施,中国慢性病将出现“井喷”。在中国慢性病已成为主要公共卫生问题,心脑血管病、糖尿病、恶性肿瘤等慢性病的患病人数约2亿人。因慢性病死亡的人数已经占到了全国因病死亡人数的80%以上。其中,脑血管病已成为我国城乡居民致死率首位的疾病。慢性病的迅速增长,不仅给人类健康带来严重的影响,也给全世界经济带来沉重的负担。如何应对中风等慢性病日趋严重的危害,是我国医疗卫生当前急需解决的重要问题。
在国外,健康管理是目前防治慢性病的最有效的办法。所谓慢性病健康管理是指以生物-心理-社会医学模式为指导,组织慢性病专业医生及护理人员,通过为健康人、慢性病风险人群、慢性病患者提供全面、连续、主动的健康管理,以达到促进健康、延缓慢性病进程、减少并发症、降低伤残率、延长寿命、提高生活质量,同时降低医疗费用为目的的一种科学健康管理模式。近年来,国内也逐渐开始了对慢病健康管理的研究,但理论研究与技术应用起步较晚,与国外健康管理相比,存在很大的差距。盲目跟随西方发达国家模式,形式单一,健康管理网络信息技术应用还未普及。
中医药防治慢性病具有独特的优势,特别是在中风病的治疗上,积累了丰富的经验。祖国医学向来注重“治未病”思想,以整体观念和辩证论治为指导来维护人类的健康。辨证论治是一个动态的过程,三因制宜理论能对健康状态的变化进行客观描述,并有效评估疾病的危险因素,从而对个人健康进行整体权衡和干预。具有中医特色的诊疗手段更能丰富现代健康管理的内容。
慢病健康管理系统是进行有效健康管理的必要工具,目前国内应用于健康管理的软件主要由三大类组成：一类是健康体检信息管理系统,另一类是健康风险评估软件系统,第三类是近年研究较多的随访、宣教与干预系统。但真正适合临床慢病管理应用的综合性信息系统非常少,具有中医特色的慢病健康管理体系还尚未建立,针对中风慢病管理的中医健康管理系统更是凤毛麟角。
随着慢病健康管理的逐步展开,将有大量形式多样的临床数据形成,传统的手工处理方式已不能满足慢病健康管理规模化的需求,特别是定性化的中医证候、症状和中医体质类型信息,以及定量化的实验室指标和影像功能检查信息等数据的产生,传统的手工分析处理方式费时耗力,无法保证健康管理业务的质量与效率。随着健康管理网络信息技术的发展,对慢性病进行有中医特色的、网络化、规模化、系统化的管理是我国慢病防治的迫切需求。
研究目的
本论文在理论研究和实证研究相结合的指导原则下,通过文献研究与临床实际需求调查,采用专家咨询法,编制中风慢病健康管理系统需求分析报告,以及系统构建的详细设计方案,运用现代计算机信息技术,研发一套具有中医特色的,集诊疗、随访、宣教于一体的,系统化、智能化、网络化的中风慢病健康管理信息系统,构建中风慢病管理研究的信息模型,从而实现对中风患者全面、连续、主动的健康管理,以达到促进健康,延缓疾病进程,减少并发症,降低伤残率,延长寿命,提高生活质量,同时降低医疗费用的目的。
研究方案
本研究分为四个部分,第一部分是文献研究,主要是对中风慢病健康管理相关的文献进行收集、整理和分析,以及对目前国内健康管理软件研发情况进行分析。第二部分以专家咨询为主要手段,进行全面的中风慢病健康管理系统需求分析与可行性分析,并制定系统构建的需求方案。第三部分根据需求分析,以中医理论的专业指导,对系统功能模块进行详细设计,实现系统基本架构和数据库结构,完成系统软件开发。第四部分运用初步开发的信息系统在广东省中医院脑血管病中心进行试运行,以发现问题和进一步完善系统。
研究结果
第一部分
(1)对我国中风慢病健康管理研究概况进行了文献分析。总体上我国慢性病防治形势严峻,中风病已成为我国居民致死率首位的疾病；国内对中风病的健康管理基础性研究还不足,对中风患者的行为调查、健康教育及其效果评价等缺乏研究。对中风患者的健康管理等基础数据库尚未建立,有中医特色的健康评估、健康需求、健康管理模式和系统理论框架等研究也相对较少。(2)总结了中医对慢病健康管理的研究进展；中医治未病思想与中风慢病健康管理的理论研究；以及慢病健康管理的中医评估手段与干预方法研究。(3)分析了目前国内健康管理软件的研发情况,主要有三类,一是体检类信息管理系统；二是健康风险评估软件系统；第三类是随访软件,主要是对所管理的人群进行定期的随访,功能以提醒、信息发送为主。但真正适合慢性病健康管理的综合性临床信息管理系统研究较少,有中医特色的中风慢病健康管理系统尚未建立。(4)对构建有中医特色的中风慢病管理系统的必要性作了详细的阐述。
第二部分
(1)总结我国慢病管理系统存在的问题以及我院中风慢病管理系统的不足,制定系统构建的总体需求、系统功能目标、系统性能目标及可行性分析,并制定系统设计总体原则。(2)在文献研究、外围调查的基础上,根据实际工作需要,经过多部门10余位专家及相关科室工作人员3次专场讨论会,对系统的每一细节进行细致的讨论,并最终确定了系统的功能需求与具体研究内容。
第三部分
(1)选择“面向对象方法”为系统开发方案,以三层B/S技术为基础系统架构的技术,运用FileMaker Pro Advanced 11.0进行系统体系结构设计与开发；网络服务器基于微软Windows 2003 Server网络操作系统。以数据信息在系统运作中的流向为主线,对中风慢病管理系统软件框架进行初步设计。(2)系统主要设计为八个主要的功能模块：信息管理模块、慢门管理模块、随访管理模块、宣教管理模块、查询管理模块、统计分析模块、系统设置模块和帮助手册模块。(3)信息管理模块主要是对患者进行mRS评分与病情评估,以及录入其个人信息和既往史、住院诊断、主要治疗、出院带药、量表评分、影像学评价、检化指标等；慢门管理模块主要是对门诊患者病情进行评估及干预,并记录相关信息；随访管理模块主要是对应随访患者进行自动提醒,提供随访记录信息表以及为患者发送相关健康信息等；宣教管理模块主要是记录患者参与健康教育的情况,以及发送宣教提示信息；查询管理模块主要是实现对系统信息的查询功能；统计管理模块则是对系统信息进行统计分析,并作出相应的统计图；系统管理模块主要是对系统的登录账户进行添加、修改、删除等工作；帮助手册模块即系统用户手册,详细介绍了本系统的功能与操作流程以及操作步骤,并对容易出错的地方给予了特别的提示。(4)根据数据库设计的相关国标,从逻辑设计、物理设计、调试运行及维护改进三方面进行中风慢病管理系统数据库的构建。(5)系统开发的实现。
第四部分
对中风慢病管理系统进行应用测试,系统运行正常,基本达到了课题组预期的功能设计；通过对系统数据库的统计分析,得出了一些较有价值的科研信息；结果还表明,我院脑血管病中心中风慢病管理工作进展顺利,但也存在许多需要完善的地方。
研究结论
(1)祖国医学博大精深、源远流长,理论体系和辨治方法自成一体,独具特色,中医学的整体观念、辨证论治、养生理论等,对人群健康评估与干预具有独特的优势,极大的丰富了慢病健康管理的手段。
(2)目前慢病健康管理软件主要以西医学为主导,且功能大都较为独立,具有传统中医特色的健康管理系统很少。因此,建立以中医理论为指导,集评估、干预、互动、随访、宣教等多功能一体的,智能化、网络化的健康管理系统有着重要的意义。
(3)在缺乏足够统计数据和可借鉴先例的情况下,成功运用专家咨询法,制定出中风慢病管理系统的需求分析与构建方案,为实现本系统的总体功能目标打下了坚实的基础。
(4)中风慢病管理信息系统是有中医特色的慢病健康管理工具,从某种意义上讲,是对古今中医健康管理理念与现代慢病管理思维的融合,是慢病健康管理服务规模化、标准化的需求,体现了中医理论与现代科学技术的结合。
(5)中风慢病管理系统是对慢病管理方法的积极探索,建立了中风慢病健康管理研究的信息模型,促进了慢病管理网络化健康信息技术的发展,满足了临床与科研工作的需求,为维护人类健康提供了新导向。
Background
According to the WHO statistics,2005 years about 3500 million people died of chronic diseases,60% of the total deaths of the world, and that in 2020 will rise to 70%. Equivalent to infectious diseases and progesterone production and perinatal disorders and nutritional deficiencies of the total number of deaths from two times,80% of which will take place in developing countries. Health minister proposed, if there is no effective preventive measures, China chronic disease will appear "blowout". Chronic diseases in China has become main public health problem, cardio-cerebrovascular disease, diabetes, cancer and other chronic cases about 2 billion people. The death toll of chronic diseases national due to illness accounted for more than 80% of all deaths. Among them, cerebrovascular disease has become China's urban and rural residents of deadly disease first. The rapid growth of chronic disease, Not only give a serious impact human health, Also to the world economy from a heavy burden. How to deal with the serious harm of chronic diseases, such as stroke, is the country's medical current urgent important problem.
In a foreign country, health management is currently the most effective way of prevention and control the chronic. Chronic health management refers to the biological—psychological-social medical model as a guide, which is organization chronic professional doctors and nurses for people of healthy, chronic disease, and chronic disease risk, provide comprehensive, continuous, initiative and health management, so as to achieve health promotion, slow down the process, reduce the complications, lower disability rate, prolonging life, and improve life quality, simultaneously reduce health-care costs for the purpose of a scientific health management mode. In recent years, domestic also gradually began to chronic health management research, but the theoretical research and technology application startting late, and foreign health management have quite the gap. Service mode of a single, blind copied western experiences of developed countries, health management network information technology application has not been popular.
Chinese medicine control chronic disease have a unique advantage, especially in the treatment of stroke, has accumulated rich experience. Traditional Chinese medicine has always attached great importance to "cure is not ill" thought, and use the unity of nature and the overall view, also describes the dynamic the dialectical outlook for YinRenZhiYi guidance to maintain the health of human beings. Dialectical treatment can objectively described and evaluated thinking health state change process of disease, not only can evaluate the risk factors, more can from overall condition for personal health measure and intervention. TCM characteristic diagnostic methods with more can enrich the content of modern health management.
Chronic health management system is an effective health management tools necessary, at present domestic application in health management software composed of three main categories:one kind is healthy check-up information management system, another kind is the health risk assessment software system, the third kind is mission and intervention system, which is studies more follow-up in recent years, But the real clinical slow disease management application for the comprehensive information system with Chinese characteristics is very little, the chronic health management system also has not been set up for stroke for management of chronic illness, TCM health management system more rare.
With chronic health management gradually spread, there will be a large variety of clinical data form, the traditional manual handling chronic health management already cannot satisfy the demand, especially scale the quanlitative syndromes, symptoms and TCM type of constitution information, and quantitative laboratory index and image data such as function test information of generation, the traditional manual analysis approach time-consuming litigation, cannot assure health management business quality and efficiency. As health management network of the development of information technology, the TCM characteristic with chronic diseases, network, and scale, systematic management is the urgent needs of our chronic disease prevention.
Objectives
This paper studies the theory and empirical studies under the guiding principle combined with clinical literature research, through actual demand survey, using Delphi method, prepare stroke chronic health management system requirements analysis report, and system construction of the detailed design proposal, use modern computers and information technology, developing a set of TCM characteristic, set with diagnosis and follow-up, mission in the integration of, systematic, intelligent, networked stroke chronic health management information system, constructing the stroke of chronic management research information model, so as to achieve all-round, continuous, active health management to stroke patients, so as to achieve to promote health, to delay the disease process, reduce the complications and reduce disability rate, prolong life and improve the quality of life, and reduce the purpose of medical expense.
Design
This research is divided into four parts, the first part is the literature research, mainly for stroke chronic health management related literature collecting, sorting and analyzing on the domestic, and the health management software development situation analysis. The second part to expert consultation as main means, for more comprehensive stroke chronic health management system requirements analysis and feasibility analysis, system construction demand plan formulated. The third part to demand analysis in Chinese medicine theory as the basis, the professional guidance system functional modules of the system, and the detailed design of the basic structure and realizing database, complete system software development. The fourth part use the information system we developed in Guangdong hospital of traditional Chinese medicine, cerebrovascular disease center to find problems and trial run, further improve the system.
Result
Part one
(1) To analysis of our country stroke chronic health management research situation. Overall, the grim situation in chronic diseases prevention and cure disease has become China's residents stroke mortality first diseases; Domestic to stroke disease health management basic research for stroke patients insufficient still, the behavior of education and its investigation and health effect evaluation of the lack of research such as. To stroke patients health management foundation database is yet to be established, a characteristic of traditional Chinese medicine health assessment, health needs, health management model and system theory frame of study also relatively small. (2) Summarized the health management of traditional Chinese medicine research progress of chronic diseases; Heal is not ill health management ideas and stroke theoretical studies of chronic diseases; And chronic health management means and intervention methods TCM assessment. (3) Analysis of the current domestic health management software development situation, there are three major types, a medical information management system is; second is health risk assessment software system; The third category is mostly for follow-up software, management for periodic follow-up crowd, functions as remind, information sent primarily. But really suitable for chronic health management integrated clinical information management system of TCM characteristic is less, have chronic health management system stroke has not been set up. (4) The necessary of setting up TCM characteristic of chronic disease management system for stroke detail.
Part two
(1) The paper summarizes the problems existing in the system of chronic disease management and our lack of chronic disease management system stroke, formulate the overall demand system construction, system function, the system performance objectives and goals and make the feasibility analysis, system design general principles. (2) In the literature research, peripheral based on investigation, according to the actual need of work through multiple departments, more than 10 experts and relevant department staff three times to the special seminars, each detail system meticulous discussion, and ultimately determine the system function demand and concrete research content.
Part three
(1) Selection "object-oriented method" for system development plan, with three layers based on B/S technology system architecture technology, use FileMaker Pro 11.0 on the system architecture design and development; Network based on Microsoft Windows Server 2003 Server network operating system. In data information in the system as the main line, the operation flow for stroke chronic disease management system software framework for preliminary design. (2) System mainly designed for eight main function modules:information management module, chronic disease outpatient management module, follow-up management module, mission management module, inquires the management module, statistical analysis module, system Settings module and help manual module. (3) Information management module is mainly to the patients with disease assessment mRS rating, and recorded their personal information and previous medical history, be in hospital diagnosis, the main therapy, discharge take medicine, rating scale and imaging evaluation, inspection geochemical index, etc.; Chronic disease outpatient management module is mainly to the clinic patients assessment and illness, and record information related to intervene; Follow-up management module mainly is corresponding to the patients were followed-up for automatic remind, provide follow-up record information table for patients and send information related to health, etc.; Mission management module mainly involved in health education is record patients, and send mission hint information; Inquires the management module mainly is to realize the search function of system information; Statistical management module of system information is statistically analyzed, and make corresponding statistical figure; System management module is mainly to the system login account for add, modify and delete etc; Help manual module namely system user manual, detailed introduces the system function and operation process and procedure of the error-prone place and gave special hints. (4) According to the database design related gb, from logical design, physical design and debug operation and maintain and improve three aspects of stroke chronic disease management system database construction. (5) The realization of system development.
Part four
For stroke chronic disease management system application testing, the system operating normally, basically reaching the functional design of our expectations; Through the statistical analysis of system database, gets some more valuable scientific research information; The results also show that our cerebrovascular disease, chronic disease management center stroke smoothly, but there are also many needs to perfect place.
Conclusion
(1) The motherland medicine after a long historical process and formed unique theory system and the differentiation method of disease, its overall view, syndrome differentiation and treatment, the health care technology, to a crowd of health assessment and intervention has unique advantages, greatly enriched the chronic health management means.
(2) Current chronic health management software is mainly for leading, and west medicine, has mostly an independent function characteristic of traditional Chinese medicine health management systems rarely. Therefore, establishing Chinese medicine theory as the guide, set assessment, intervention, interactive and follow-up, mission, etc, intelligent, and a multifunctional network health management system has important significance.
(3) In the absence of adequate statistical data and can draw lessons from the case, successful precedent using Delphi method and work out the stroke of chronic disease management system requirements analysis and construction scheme for the realization of this system, overall functional target to lay a solid foundation.
(4) The construction of stroke chronic management system in a certain extent, realize the management idea and ancient Chinese medicine health fusion of modern chronic disease management thinking, is chronic health management service scale and standard needs, Chinese medicine theory and modern multidisciplinary technical characteristic of traditional Chinese medicine combined with a chronic health management tools.
(5) Stroke chronic disease management system is of chronic disease management method, establishes the active explorations of chronic health management research of stroke, promote the information model chronic management network health information technology development, meet the demand of clinical and scientific work for safeguarding human health, and provides a new direction.
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