CN108009390A - A kind of chronic disease medical order compliance management method and system - Google Patents
A kind of chronic disease medical order compliance management method and system Download PDFInfo
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- CN108009390A CN108009390A CN201710782149.3A CN201710782149A CN108009390A CN 108009390 A CN108009390 A CN 108009390A CN 201710782149 A CN201710782149 A CN 201710782149A CN 108009390 A CN108009390 A CN 108009390A
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Abstract
The invention discloses a kind of chronic disease medical order compliance management method and system, it is related to chronic disease management domain；Its method and step includes information acquisition module collection information and generates disease storehouse and doctor's advice template；System diagnostics module carries out classification diagnosis；Doctor's advice management module flexibly formulates doctor's advice；Medical order compliance management module is assessed and intervention compliance；Condition assessment module periodically carries out reformulating doctor's advice according to recovery situation after state of an illness comprehensive assessment, and far module is into remote management outside houses of prostitutes or actresses in the Jin and Yuan Dynasties and remote collaborative medical treatment and classification diagnosis and treatment；The present invention is centered on the management of patient's medical order compliance, utilize long-distance video medical technology and mobile telemedicine technology, and realize that medical order compliance continuously manages outside patio of institute by medical order compliance management module, medical order compliance is improved, lifts the control rate of chronic disease.
Description
Technical field
The present invention relates to chronic disease management domain, especially a kind of chronic disease medical order compliance management method and it is
System.
Background technology
Chronic disease refers to some without infectiousness, duration very long disease, such as hypertension, diabetes etc.,
Chronic disease has the characteristics that the course of disease is long, the cause of disease is complicated, Health cost and social danger are serious, it is necessary to long-term or even lifelong receiving
Treatment control, especially continuously, system and comprehensive disease control.
As medical science and technology and pharmaceutical technology develop, the guideline of prevention and treatment of chronic disease is ripe, and pharmaceutical means are also ripe,
Today's society has had been provided with the condition of effective these chronic disease state of an illness of control；China is from mid-term the 1990s in big city
City carries out the preventing and controlling of Chronic Disease in Community, but chronic disease preventing and controlling domestic at present be still mainly limited to prevention intervene,
Statistics and expense reimbursement aspect, such as whole people's physical examination, the foundation of health account, health communication and education, basic medical insurance door
Examine special disease to declare, these, which are operated in improve fitness-for-all health consciousness and collect disease control data and mitigate, suffers from
Effort and achievement are made that in person's drug cost burden, but carry out ten in terms of the disease control work of the continuous diagnosis and treatment of chronic disease
It is point limited, both without ripe continuous disease treatment service mode is formed, more do not established classification and the collaboration doctor of chronic disease
Service mode is treated, lacks the ripe Management modes of the diseases of chronic disease, the current diagnosis and treatment of the current chronic disease in China has illness
Rate is high, the two high three low features that awareness, treatment rate, control rate are low and disability rate is high；
The treatment of chronic disease needs complex treatment, therefore the treatment doctor's advice of chronic disease involves a wide range of knowledge and complicated, bag
Include medication, diet doctor's advice, movement doctor's advice, life doctor's advice, inspection doctor's advice, self-monitoring doctor's advice, further consultation doctor's advice etc.；It is and slow
Cause medical order compliance low since income is low with the degree of awareness to chronic disease in property patient, while China's non-shape at present
Into continuous disease treatment service mode and mode of medical services is classified and cooperateed with, the treatment curative effect of chronic disease is directly affected, leads
Cause chronic disease control rate low.
The content of the invention
It is an object of the invention to：The present invention provides a kind of chronic disease medical order compliance management method and system, with fixed
Centered on phase condition assessment and the management of patient's medical order compliance, using long-distance video medical technology and mobile telemedicine technology,
And solve the problems, such as that existing chronic disease medical order compliance is low by information platform technology, realize medical order compliance assessment and it is chronic
Disease condition is assessed, and is improved the Quality of medical order of basic medical unit chronic disease and the medical order compliance of patients with chronic diseases, is reached
To the control rate purpose of lifting chronic disease.
A kind of chronic disease medical order compliance management method, includes the following steps：
Step 1：Information acquisition module is established collecting unit collection patient basis and is sent to system diagnostics module, and builds
Vertical disease database and doctor's advice template；
Step 2：System diagnostics module carries out classification diagnosis according to the essential information combination disease database, and will diagnosis
As a result it is sent to doctor's advice management module；
Step 3：Doctor's advice management module establishes doctor's advice unit, and cycle planning is formulated with reference to the diagnostic result and doctor's advice template
Doctor's advice, and establish cycle doctor's advice recording unit；
Step 4：Doctor's advice management module establishes doctor's advice unit outside institute, and short-term doctor's advice outside institute is formulated according to cycle planning doctor's advice,
Start order data outside cycle doctor's advice logging modle record institute and order data outside institute is sent to medical order compliance management module；
Step 5：Medical order compliance management module establishes assessment unit, and carrying out compliance with reference to order data outside the institute comments
Estimate, establish and intervene unit and sent into the inner tube reason Data Concurrent that must leave hospital after compliance intervention in houses of prostitutes or actresses in the Jin and Yuan Dynasties to remote supervision module and the state of an illness
Assess management module；
Step 6：Remote supervision module establishes remote management unit, with reference to managing data in the institute into compliance outside houses of prostitutes or actresses in the Jin and Yuan Dynasties
The outer tube that must leave hospital after intervention reason Data Concurrent is sent to condition assessment management module；
Step 7：Condition assessment management module establishes audit report unit and condition assessment unit, is managed with reference to outside the institute
Data are managed in data and institute and carry out regular condition assessment, judge whether state of an illness recovery situation is good according to assessment result, if so,
Then terminate compliance management, otherwise return to step 2 revision diagnosis and adjustment cycle planning doctor's advice.
Preferably, doctor's advice management module establishes doctor's advice unit outside institute in the step 4, and institute is formulated according to cycle planning doctor's advice
Outer short-term doctor's advice comprises the following steps：
Step 4.1：Doctor's advice management module establishes doctor's advice unit outside institute, and doctor's advice unit is established according to cycle planning doctor's advice outside institute
Diet doctor's advice, movement doctor's advice, bad habit doctor's advice；
Step 4.2：The doctor's advice combination doctor's advice template that doctor's advice unit is formulated according to step 4.1 outside institute formulates medication, and
Establish arrangement, plan and prompting that alarm clock examination ＆ verification unit carries out the medication frequency according to medication；
Step 4.3：The doctor's advice that doctor's advice unit combination step 4.1 and step 4.2 are formulated outside institute formulates self-monitoring doctor outside institute
Advise, and establish institute's external monitor unit into self-monitoring examination ＆ verification and monitoring outside houses of prostitutes or actresses in the Jin and Yuan Dynasties；
Step 4.4：The doctor's advice that doctor's advice unit is formulated according to step 4.1,4.2 and 4.3 outside institute formulates follow-up doctor's advice, and establishes
Reservation management unit completes reservation follow up time.
Preferably, the step 5 specifically includes following steps：
Step 5.1：Medical order compliance management module establishes assessment unit and carries out drug compliance assessment and non-drug compliance
Property assessment, intervention unit will be sent in assessment result；
Step 5.2：It is single according to assessment result foundation communication unit, adjustment unit, verification unit, training to intervene unit
Member and administrative unit are carried out doctor's advice communication, doctor's advice adjustment by flow successively, doctor's advice is verified, doctor's advice is trained, reservation management intervention；
Step 5.3：Intervention unit terminates to preserve management Data Concurrent in institute after intervening and gives remote supervision module and the state of an illness
Assess management module.
Preferably, medical order compliance intervention specifically includes following steps outside step 6 institute：
Step 6.1：Remote supervision module establishes remote management unit according to management data in the institute；
Step 6.2：Remote management unit establishes query unit, reminding unit and feedback unit and completes doctor's advice inquiry, medication
Time inquiring and medical order compliance feedback record simultaneously preserve data are managed outside institute；
Step 6.3：Remote management unit will manage data sending and give condition assessment management module outside institute.
Preferably, following steps are specifically included in the step 5.1：
S1：Medical order compliance management module establishes special element and assessment unit, and assessment unit carries out drug compliance and comments
Estimate and assessed with non-drug compliance, assessment result is sent to special element；
S2：Special element receives assessment result and judges whether the merging disease of patient changesIf so, it then will determine that knot
Fruit is sent to remote supervision module；Otherwise, then assessment result is sent to intervention unit；
S3：Remote supervision module receives judging result and establishes remote collaborative medical video unit and classification diagnosis and treatment examination ＆ verification list
Member, classification diagnosis and treatment examination ＆ verification unit carries out classification diagnosis and treatment application examination ＆ verification, while preengages the collaboration medical time；
S4：Remote supervision module starts remote collaborative medical video unit progress long-distance video according to the collaboration medical time and begs for
By going to step 3 and formulate new cycle planning doctor's advice.
A kind of chronic disease medical order compliance management system, including information acquisition module, chronic disease system diagnostics module,
Doctor's advice management module, medical order compliance management module, condition assessment management module and remote supervision module, wherein
Information acquisition module, establishes collecting unit collection patient basis and sends to system diagnostics module, and establishes disease
Kind database and doctor's advice template；
System diagnostics module, for receiving individual and disease essential information, with reference to disease dictionary and conjunction in disease database
And disease dictionary carries out classification diagnosis, and diagnostic result is sent to doctor's advice management module；
Doctor's advice management module, for establishing doctor's advice unit, cycle planning is formulated with reference to the diagnostic result and doctor's advice template
Doctor's advice, and establish cycle doctor's advice recording unit；Doctor's advice unit outside institute is established, short-term doctor outside institute is formulated according to cycle planning doctor's advice
Advise, start order data outside cycle doctor's advice logging modle record institute and order data outside institute is sent to medical order compliance management mould
Block；
Medical order compliance management module, for establishing assessment unit, carries out compliance with reference to order data outside the institute and comments
Estimate, establish and intervene unit and sent into the inner tube reason Data Concurrent that must leave hospital after compliance intervention in houses of prostitutes or actresses in the Jin and Yuan Dynasties to remote supervision module and the state of an illness
Management module is assessed, is established and is sent to remote supervision module after special element receives assessment result and intervenes unit；
Remote supervision module, establishes remote management unit, and remote management unit manages data with reference to compliance in the institute
Query unit, reminding unit and feedback unit are established into compliance intervention outside houses of prostitutes or actresses in the Jin and Yuan Dynasties, the outer tube that must leave hospital reason Data Concurrent is sent to disease
Feelings assess management module；Establish remote collaborative medical video unit and classification diagnosis and treatment examination ＆ verification unit realizes classification diagnosis and treatment and long-range association
With medical treatment；
Condition assessment management module, for establishing audit report unit and condition assessment unit, manages with reference to outside the institute
Data are managed in data and institute and carry out regular condition assessment, system diagnostics module revision diagnosis and adjustment are gone to according to assessment result
Cycle planning doctor's advice.
In conclusion by adopting the above-described technical solution, the beneficial effects of the invention are as follows：
(1) present invention is centered on regular condition assessment and the management of patient's medical order compliance, using information platform and remotely
Medical technology is continuously managed into medical order compliance outside medical order compliance in houses of prostitutes or actresses in the Jin and Yuan Dynasties and institute, improves medical order compliance, and according to doctor
Compliance dynamic evaluation state of an illness adjustment diagnosis and doctor's advice are advised, the Quality of medical order of basic medical unit chronic disease is improved, so as to reach
To the purpose of the control rate of lifting chronic disease；
(2) medical order compliance management of the invention carries out workflow management after being performed from doctor's advice, according to doctor during patient's further consultation
Advise to perform to record and carry out formulating personalized according to result adjustment doctor's advice, in due course variation doctor's advice after assessing drug actions and non-drug assessment
Doctor's advice, then carries out doctor's advice training and reminds, in institute medical order compliance management process management further improve medical order compliance；
(3) medical order compliance management includes doctor's advice inquiry, time alarm, report queries and medication outside institute outside institute of the invention
Time feedbacking, self-monitoring result are fed back and the online education of relevant disease knowledge, is managed outside institute and utilizes information platform emphatically
Reminded, improve the Quality of medical order of basic medical unit chronic disease, further improve medical order compliance；
(4) medical order compliance management is managed using intervention means in institute of the invention and outside institute, from knowledge lecture
The cognition to disease is improved, knowledge needed for therapeutic process or operation give training, and medical order compliance is continuous outside patio of institute
Management further improves institute's medical order compliance, improves the control rate of chronic disease；
(5) diagnosis incipience of the invention carries out classification diagnosis according to disease database combination medical insurance disease dictionary, reduces and suffers from
Person's financial burden, while classification diagnosis is beneficial to anaphase curative effect, the later stage is according to medical order compliance and condition assessment revision diagnosis
Doctor's advice is adjusted, improves treatment curative effect, improves the control rate of chronic disease；
(6) remote management utilizes telemedicine network technology outside institute of the present invention, based on innovation classification Diagnosis-treat Model theory and
Various chronic disease condition assessment methods, cooperate with professional medical resources at different levels and each to realize that periodically the state of an illness is commented comprehensively to chronic disease
Estimate, effectively improve treatment curative effect, easy to anaphase flow, further improve the control rate of chronic disease.
Brief description of the drawings
Examples of the present invention will be described by way of reference to the accompanying drawings, wherein：
Fig. 1 is flow chart of the method for the present invention；
Fig. 2 is step 4 method flow diagram of the present invention；
Fig. 3 is step 5 method flow diagram of the present invention；
Fig. 4 is step 6 method flow diagram of the present invention；
Fig. 5 is step 5.1 method flow diagram of the present invention.
Embodiment
All features disclosed in this specification, or disclosed all methods or during the step of, except mutually exclusive
Feature and/or step beyond, can combine in any way.
Elaborate with reference to Fig. 1-5 couples of present invention.
A kind of chronic disease medical order compliance management method, includes the following steps：
Step 1：Information acquisition module is established collecting unit collection patient basis and is sent to system diagnostics module, and builds
Vertical disease database and doctor's advice template；
Step 2：System diagnostics module carries out classification diagnosis according to the essential information combination disease database, and will diagnosis
As a result it is sent to doctor's advice management module；
Step 3：Doctor's advice management module establishes doctor's advice unit, and cycle planning is formulated with reference to the diagnostic result and doctor's advice template
Doctor's advice, and establish cycle doctor's advice recording unit；
Step 4：Doctor's advice management module establishes doctor's advice unit outside institute, and short-term doctor's advice outside institute is formulated according to cycle planning doctor's advice,
Start order data outside cycle doctor's advice logging modle record institute and order data outside institute is sent to medical order compliance management module；
Step 5：Medical order compliance management module establishes assessment unit, and carrying out compliance with reference to order data outside the institute comments
Estimate, establish and intervene unit and sent into the inner tube reason Data Concurrent that must leave hospital after compliance intervention in houses of prostitutes or actresses in the Jin and Yuan Dynasties to remote supervision module and the state of an illness
Assess management module；
Step 6：Remote supervision module establishes remote management unit, and data are managed into outside houses of prostitutes or actresses in the Jin and Yuan Dynasties with reference to compliance in the institute
The outer tube that must leave hospital after compliance intervention reason Data Concurrent is sent to condition assessment management module；
Step 7：Condition assessment management module establishes audit report unit and condition assessment unit, is managed with reference to outside the institute
Data are managed in data and institute and carry out regular condition assessment, judge whether state of an illness recovery situation is good according to assessment result, if so,
Then terminate compliance management, otherwise return to step 2 revision diagnosis and adjustment cycle planning doctor's advice.
A kind of chronic disease medical order compliance management system, including information acquisition module, chronic disease system diagnostics module,
Doctor's advice management module, medical order compliance management module, condition assessment management module and remote supervision module.
Embodiment 1
Information acquisition module establishes collecting unit collection demographic information, personal medical insurance information, chronic disease diagnosis
Information, chronic disease auxiliary diagnosis data information, present illness history information, medical history information, personal history and family history information and
The essential informations such as unique archive information, and send to system diagnostics module, establish disease database and doctor's advice template；
System diagnostics module carries out classification diagnosis according to the essential information combination disease database, and diagnostic result is sent out
Give doctor's advice management module；
Doctor's advice management module establishes doctor's advice unit, and cycle planning doctor's advice is formulated with reference to the diagnostic result and doctor's advice template,
And establish cycle doctor's advice recording unit；Doctor's advice management module establishes doctor's advice unit outside institute, is formulated according to cycle planning doctor's advice outside institute
Short-term doctor's advice, starts order data outside cycle doctor's advice logging modle record institute and order data outside institute is sent to medical order compliance
Management module；Such as trimestral cycle planning doctor's advice, then first month then performs doctor's advice to be short-term outside institute outside institute；Cured outside institute
Unit is advised to establish diet doctor's advice, movement doctor's advice, bad habit doctor's advice according to doctor's advice template；Doctor's advice unit is according to upper step by step rapid outside institute
The doctor's advice combination doctor's advice template of formulation formulates medication, and establishes alarm clock examination ＆ verification unit and carry out the medication frequency according to medication
Arrangement, plan and prompting；Two doctor's advices formulated suddenly step by step improve doctor's advice template and formulate self prison outside institute on doctor's advice unit outside institute
Doctor's advice is surveyed, and establishes institute's external monitor unit and completes into self-monitoring examination ＆ verification and monitoring outside houses of prostitutes or actresses in the Jin and Yuan Dynasties；Doctor's advice unit is according to upper step outside institute
The doctor's advice that step is formulated formulates follow-up doctor's advice, and establishes reservation management unit and complete reservation follow up time.
Medical order compliance management module establishes assessment unit, carries out compliance assessment with reference to order data outside the institute, builds
Vertical unit of intervening is sent to remote supervision module and disease into the interior compliance management Data Concurrent that must leave hospital after compliance intervention in houses of prostitutes or actresses in the Jin and Yuan Dynasties
Feelings assess management module, establish intervention unit and intervene the inner tube reason data that must leave hospital into compliance in houses of prostitutes or actresses in the Jin and Yuan Dynasties, and will manage number in institute
According to being sent to remote supervision module and condition assessment management module；Medical order compliance management module establishes assessment unit and carries out medicine
Compliance is assessed and the assessment of non-drug compliance, intervention unit will be sent in assessment result；Specific steps：Assessment result is first
It is sent to special element；Special element receives assessment result and judges that the merging disease of patient changesIf so, it then will determine that knot
Fruit is sent to remote supervision module；Otherwise, then assessment result is sent to intervention unit；Remote supervision module receives judging result
Remote collaborative medical video unit and classification diagnosis and treatment examination ＆ verification unit are established, classification diagnosis and treatment examination ＆ verification unit carries out classification diagnosis and treatment application and examines
Core, while preengage the collaboration medical time；Remote management unit starts remote collaborative medical video unit according to the collaboration medical time
Long-distance video discussion is carried out, doctor's advice management module is gone to and formulates new cycle planning doctor's advice.Intervene unit reception assessment result to build
Vertical unit, adjustment unit, verification unit, training unit and the administrative unit linked up is carried out doctor's advice communication, doctor's advice tune by flow successively
Whole, doctor's advice is verified, doctor's advice is trained, reservation management intervention；Intervention unit terminates to preserve management Data Concurrent in institute after intervening and gives
Remote supervision module and condition assessment management module；If assessment finds that patient compliance is low, then linked up, if objective
Reason, doctor need to change doctor's advice, such as the doctor's advice of one month according to finding, change medication frequency etc.；It is if subjective former
Cause, then carry out doctor's advice verification, training and prompting according to concrete reason, for example, how insulin injection, how using blood glucose meter etc.,
Medical order compliance management is mainly according to information platform into outside houses of prostitutes or actresses in the Jin and Yuan Dynasties when doctor's advice inquiry, time alarm, report queries and medication outside institute
Between feedback, self-monitoring result feedback and relevant disease knowledge online education.
Remote supervision module establishes remote management unit, after management data are intervened into compliance outside houses of prostitutes or actresses in the Jin and Yuan Dynasties in the institute
The outer compliance management Data Concurrent that must leave hospital is sent to condition assessment management module；Specially：Remote supervision module is according to the institute
Interior management data establish remote management unit；Remote management unit establishes query unit, reminding unit and feedback unit and completes doctor
Advise inquiry, administration time inquiry and medical order compliance feedback record and preserve compliance outside institute and manage data；Doctor's advice is complied with outside institute
Property management module will outside institute manage data sending give condition assessment management module；
Condition assessment management module establishes audit report unit and condition assessment unit, with reference to outside the institute manage data and
Compliance management data carry out regular condition assessment in institute, and system diagnostics module revision diagnosis and adjustment are returned to according to assessment result
Cycle planning doctor's advice.
Using Tele medicine combined innovation be classified Diagnosis-treat Model theory and various chronic disease condition assessment methods into
Row condition assessment, diagnosis adjustment doctor's advice is revised according to condition assessment result, according to medical order compliance assessment result into curing in houses of prostitutes or actresses in the Jin and Yuan Dynasties
Compliance is advised to train, medical order compliance is reminded outside institute, adjusts doctor's advice in due course, improves Quality of medical order, it is ensured that patient's medical order compliance,
Improve the control rate of chronic disease.It is managed in another aspect institute with medical order compliance management outside institute using intervention means,
The cognition to disease is improved from knowledge lecture, knowledge needed for therapeutic process or operation give training, doctor's advice outside patio of institute
Continuously management further improves institute's medical order compliance to compliance, improves the control rate of chronic disease, reduces and suffers from reference to medical insurance policies
Person's financial burden, continuous management outside patio of medical order compliance institute, management process, all promotes the raising of compliance, improves doctor's advice
Quality and treatment curative effect, improve the control rate of chronic disease.
Embodiment 2
Information acquisition module is established collecting unit collection patient basis and is sent to system diagnostics module, and establishes disease
Database and doctor's advice template；
Information is as follows：Patient's demographic information；Personal medical insurance information includes medical insurance type, medical insurance card number；Chronic disease
Sick diagnostic message include patient source, head examine doctor, chronic disease (medical insurance identification/application) disease, chronic disease medical insurance identification/
The date is assert in upper cycle application hospital, chronic disease medical insurance；Chronic disease auxiliary diagnosis data information includes case history, chemical examination report
Announcement, image check report etc.；Present illness history information includes existing symptom, existing basic data (blood pressure, pulse frequency, refer to blood glucose, height,
Weight, abdominal circumference, BMI values), existing abnormal sign；Medical history information include personal history and family history information smoking bad habit,
Drink bad habit, first degree relative is early made up one's mind blood vessel medical history；Unique archive information includes electronic record number, archives of paper quality number, builds
Shelves date, the people that files, file section office.
System diagnostics module carries out classification diagnosis according to the essential information combination disease database, and diagnostic result is sent out
Give doctor's advice management module；
By taking medical insurance assert that disease is " high blood pressure " as an example, chronic disease system diagnostics module is briefly described：Doctor
Protect chronic disease disease diagnostic module selection " high blood pressure "；Simultaneously because lipid examination finds " cholesterolemia increases ", neck
Color-Doppler ultrasound finds " carotid plaques " and electrocardio graph discovery " myocardial ischemia ", therefore chronic disease merges the selection of medical diagnosis on disease module
" hyperlipidemia ", " carotid atherosclerosis " and " myocardial ischemia " three diseases.
Doctor's advice management module establishes doctor's advice unit, and cycle planning doctor's advice is formulated with reference to the diagnostic result and doctor's advice template,
And establish cycle doctor's advice recording unit；Doctor's advice unit outside institute is established, short-term doctor's advice outside institute is formulated according to cycle planning doctor's advice, is started
Cycle doctor's advice logging modle records order data outside institute and order data outside institute is sent to medical order compliance management module.
By taking simple " high blood pressure " (temporarily without merging disease) as an example, doctor's advice management module is briefly described：
For " high blood pressure " existing medical insurance reimbursement application system be 3 months be the cycle, according to current medical insurance medicine with
Inspection item reimbursement policy making cycle planning doctor's advice is as follows, and is applied in Executive records of doctor's order module to medical insurance office：
For " high blood pressure " patient, this is gone to a doctor from the doctor's advice in nearly January after institute, is known as " performing doctor's advice outside institute in short term ",
Including self-monitoring doctor's advice and follow-up doctor's advice outside medication, diet doctor's advice, movement doctor's advice, bad habit doctor's advice, institute.
1 box Nifedipine sustained release tablets are also retained due to the original family of the patient not use, therefore the usage and dosage of the medicine
Doctor's advice is performed by cycle planning doctor's advice, but recipe quantity will reduce by 1 box；Simultaneously because weather heating, monitoring blood pressure is relatively low recently, therefore
Need to be reduced the Irbesartan Tablets dosage in primitive period plan medication.Therefore drug prescription in this short-term execution doctor's advice
Doctor's advice is as follows：
Administration time plan is automatically generated according to medication system：7：00AM medication plans；Nifedipine sustained release tablets 1
Grain；Irbesartan Tablets 1；Aspirin enteric coated tablet 1.
Follow up time is preengage in reservation management module, and follow-up doctor's advice is as follows after patient January：
Reservation type：Carry out institute's further consultation；Day of appointment：2017-4-1
Carry out institute's type：Further consultation；Carry out institute's time reservation：2017-4-1 8：50AM
The doctor's advice of other doctor's advices formulates mode according to doctor's advice stencil-chosen：
Diet doctor's advice：High blood pressure diet doctor's advice masterplate 1；Move doctor's advice：High blood pressure movement doctor's advice masterplate 3；It is bad thermophilic
Good doctor's advice：Bad habit doctor's advice masterplate 2；Self-monitoring doctor's advice outside institute：Hypertension self-monitoring doctor's advice masterplate 1.
Medical order compliance management module establishes assessment unit, carries out compliance assessment with reference to order data outside the institute, builds
Vertical unit of intervening is sent to remote supervision module and disease into the interior compliance management Data Concurrent that must leave hospital after compliance intervention in houses of prostitutes or actresses in the Jin and Yuan Dynasties
Feelings assess management module, by taking high blood pressure as an example：Find that patient has interruption to stop by compliance evaluation module when patient is to go to a doctor
Medicine situation, carries out communication and finds patient's drug withdrawal the reason is that worrying that blood pressure recovery normally continues medication and low blood pressure occurs afterwards, and
Occasionally there is stomachache symptom after taking medicine.For the worry of patient, doctor informs principle of patient's Sustained drug to blood concentration stable state, with
And the blood concentration stablized is to the importance of stabilizing blood pressure.
According to patient's stomachache symptom, doctor considers may be related with wherein aspirin side effect, therefore adjusts aspirin
That takes is postprandial by being changed to before the meal with the relation of having dinner, and Effect of follow-up visit by telephone after preengaging 3 days.
The short-term execution doctor's advice adjusted according to doctor, verifies module and cycle planning doctor's advice is verified, while inquire trouble
The kind and usage and dosage of person's medication, grasp of the assessment patient to doctor's advice.
After patient is 3 days from institute, Effect of follow-up visit by telephone patient symptom of having a stomachache has improved disappearances, and presses doctor's advice medication, self is supervised
Survey doctor's advice not carry out, the reason is that the electronic sphygmomanometer of oneself purchase can not often measure.
According to Effect of follow-up visit by telephone as a result, the family doctor that training module preengages next day for patient makes a round of visits, visited by family doctor
Make a round of visits.Make a round of visits middle discovery Patients ' Electronic sphygmomanometer operating mistake, training module plays out electronic blood pressure and use video, and doctor helps
Manage and aid in training and demonstrate.
Effect of follow-up visit by telephone after 3 days is preengage again by family after making a round of visits, after 3 days after Effect of follow-up visit by telephone patient, management module is done for patient
The further consultation preregistration formality of Li Lai institutes.
Condition assessment management module establishes audit report unit and condition assessment unit, with reference to outside the institute manage data and
Data are managed in institute and carry out regular condition assessment, step 2 revision diagnosis and adjustment cycle planning doctor's advice are returned to according to assessment result.
With " high blood pressure " of 42 years old for example：
According to high blood pressure basic unit guideline of prevention and treatment, the Con trolling index of high blood pressure is pressure value, which is less than 65
In year, the value up to standard of blood pressure is " below 140/90mmHg ".It is up to standard to controlling of blood pressure according to patient's reach mark blood pressure situation in the present invention
Assessment is divided into stably reaching standard, up to standard but unstable, below standard 3 assessment results.Patient's this cycle blood pressure measurement 12 times, has
3 times in more than 140/90mmHg, other 9 pressure values are all in below 140/90mmHg.It is up to standard for the controlling of blood pressure of the patient
Assessment result is：It is up to standard but unstable.
According to existing high blood pressure basic unit guideline of prevention and treatment, the risk assessment of high blood pressure is to take risk factor layering assessment,
And be according to hypertension grading and Risk Factors of Hypertension index quantity, target organ damage index, the clinical condition that merges into
Row assessment, assessment result are divided into：Low danger, middle danger and high-risk 3 assessments level.Patient's example：
According to the past maximal blood pressure value when filing, with reference to maximal blood pressure value after filing, comprehensive descision patient's hypertension grading.
The past maximal blood pressure value is 182/98mmHg when the patient files, and maximal blood pressure value is not above the value after filing, therefore the disease
People's hypertension grading is 3 grades.Opinion of the high blood pressure basic unit guideline of prevention and treatment on hypertension grading：
| Rank | Systolic pressure (mmHg) | Diastolic pressure (mmHg) |
| I grades of hypertension (slight) | 140-159 | 90-99 |
| II grades of hypertension (moderate) | 160-179 | 100-109 |
| III level hypertension (severe) | ≥180 | ≥100 |
| Simple systolic hypertension | ≥140 | <90 |
According to existing high blood pressure basic unit guideline of prevention and treatment, Risk Factors of Hypertension index totally 5, which has smoking and fertilizer
Fat 2 hazards；(Risk Factors of Hypertension index refers to for 1, age：Male>55 years old, women>65 years old；2nd, smoking；3rd, blood fat is different
Often：T-CHOL >=5.7mmol/L, TG >=1.7mmol/L, LDL-C >=3.3mmol/L, HDL-C<1.0mmol/L；4th, early hair
Cardiovascular disease family history：First degree relative is 55 years old male, female fell ill before 65 years old；5th, it is fat or with Central obesity：BMI >=28kg/ ㎡,
Or Central obesity (waistline man >=90cm, female >=85cm)；)
According to existing high blood pressure basic unit guideline of prevention and treatment, target organ damage index totally 3, which has carotid artery intima spot
1 index of block；(target organ damage index 1, left ventricular hypertrophy；2nd, carotid artery intima thickens；3rd, patch serum creatinine slightly raises；)
According to existing high blood pressure basic unit guideline of prevention and treatment, the clinical condition of related merging totally 6, which faces without merging
Bed illness；(clinical condition of merging refers to 1, cranial vascular disease：Cerebral apoplexy, transient ischemic attack；2nd, heart disease：Coronary heart disease,
Angina pectoris, myocardial infarction, coronary reconstruction, heart failure；3rd, kidney trouble；4th, peripheral angiopathy；5th, retinopathy；6th, it is sugared
Urine disease；)
According to existing high blood pressure basic unit guideline of prevention and treatment, which is 3 grades, and hazards have 2, target device
Official's infringement has 1, thus patient's risk factor layering be evaluated as it is high-risk；
Finally assess more than, examined with reference to the remote collaborative medical video unit in remote supervision module and classification diagnosis and treatment
Nuclear unit, drafts new cycle planning doctor's advice.
Claims (6)
- A kind of 1. chronic disease medical order compliance management method, it is characterised in that：Include the following steps：Step 1：Information acquisition module is established collecting unit collection patient basis and is sent to system diagnostics module, and establishes disease Kind database and doctor's advice template；Step 2：System diagnostics module carries out classification diagnosis according to the essential information combination disease database, and by diagnostic result It is sent to doctor's advice management module；Step 3：Doctor's advice management module establishes doctor's advice unit, and cycle planning doctor is formulated with reference to the diagnostic result and doctor's advice template Advise, and establish cycle doctor's advice recording unit；Step 4：Doctor's advice management module establishes doctor's advice unit outside institute, formulates short-term doctor's advice outside institute according to cycle planning doctor's advice, starts Cycle doctor's advice logging modle records order data outside institute and order data outside institute is sent to medical order compliance management module；Step 5：Medical order compliance management module establishes assessment unit, and compliance assessment is carried out with reference to order data outside the institute, Establish to intervene unit and send to remote supervision module and the state of an illness into the inner tube reason Data Concurrent that must leave hospital after compliance intervention in houses of prostitutes or actresses in the Jin and Yuan Dynasties and comment Estimate management module；Step 6：Remote supervision module establishes remote management unit, with reference to managing data in the institute into compliance intervention outside houses of prostitutes or actresses in the Jin and Yuan Dynasties After must leave hospital outer tube reason Data Concurrent send to condition assessment management module；Step 7：Condition assessment management module establishes audit report unit and condition assessment unit, with reference to managing data outside the institute Regular condition assessment is carried out with data are managed in institute, judges whether state of an illness recovery situation is good according to assessment result, if so, then tying Beam compliance management, otherwise returns to step 2 revision diagnosis and adjustment cycle planning doctor's advice.
- A kind of 2. chronic disease medical order compliance management method according to claim 1, it is characterised in that：The step 4 Middle doctor's advice management module establishes doctor's advice unit outside institute, and formulating short-term doctor's advice outside institute according to cycle planning doctor's advice comprises the following steps：Step 4.1：Doctor's advice management module establishes doctor's advice unit outside institute, and doctor's advice unit establishes diet according to cycle planning doctor's advice outside institute Doctor's advice, movement doctor's advice, bad habit doctor's advice；Step 4.2：The doctor's advice combination doctor's advice template that doctor's advice unit is formulated according to step 4.1 outside institute formulates medication, and establishes Alarm clock audits arrangement, plan and the prompting that unit carries out the medication frequency according to medication；Step 4.3：The doctor's advice that doctor's advice unit combination step 4.1 and step 4.2 are formulated outside institute formulates self-monitoring doctor's advice outside institute, and Institute's external monitor unit is established into self-monitoring examination ＆ verification and monitoring outside houses of prostitutes or actresses in the Jin and Yuan Dynasties；Step 4.4：The doctor's advice that doctor's advice unit is formulated according to step 4.1,4.2 and 4.3 outside institute formulates follow-up doctor's advice, and establishes reservation Administrative unit completes reservation follow up time.
- A kind of 3. chronic disease medical order compliance management method according to claim 1, it is characterised in that：The step 5 Specifically include following steps：Step 5.1：Medical order compliance management module establishes assessment unit progress drug compliance assessment and non-drug compliance is commented Estimate, intervention unit will be sent in assessment result；Step 5.2：Intervene unit according to the assessment result establish link up unit, adjustment unit, verify unit, training unit and Administrative unit is carried out doctor's advice communication, doctor's advice adjustment by flow successively, doctor's advice is verified, doctor's advice is trained, reservation management intervention；Step 5.3：Intervention unit terminates to preserve management Data Concurrent in institute after intervening and gives remote supervision module and condition assessment Management module.
- A kind of 4. chronic disease medical order compliance management method according to claim 1, it is characterised in that：The step 6 Medical order compliance intervention specifically includes following steps outside institute：Step 6.1：Remote supervision module establishes remote management unit according to management data in the institute；Step 6.2：Remote management unit establishes query unit, reminding unit and feedback unit and completes doctor's advice inquiry, administration time Inquiry and medical order compliance feedback record simultaneously preserve data are managed outside institute；Step 6.3：Remote management unit will manage data sending and give condition assessment management module outside institute.
- A kind of 5. chronic disease medical order compliance management method according to claim 3, it is characterised in that：The step Following steps are specifically included in 5.1：S1：Medical order compliance management module establishes special element and assessment unit, assessment unit carry out drug compliance assessment and Non-drug compliance is assessed, and assessment result is sent to special element；S2：Special element receives assessment result and judges whether the merging disease of patient changesIf so, it then will determine that result is sent out Give remote supervision module；Otherwise, then assessment result is sent to intervention unit；S3：Remote supervision module receives judging result and establishes remote collaborative medical video unit and classification diagnosis and treatment examination ＆ verification unit, point Level diagnosis and treatment examination ＆ verification unit carries out classification diagnosis and treatment application examination ＆ verification, while preengages the collaboration medical time；S4：Remote supervision module starts remote collaborative medical video unit according to the collaboration medical time and carries out long-distance video discussion, Go to step 3 and formulate new cycle planning doctor's advice.
- A kind of 6. chronic disease medical order compliance management system, it is characterised in that：Including information acquisition module, chronic disease system Diagnostic module, doctor's advice management module, medical order compliance management module, condition assessment management module and remote supervision module, whereinInformation acquisition module, establishes collecting unit collection patient basis and sends to system diagnostics module, and establishes disease number According to storehouse and doctor's advice template；System diagnostics module, for receiving individual and disease essential information, with reference to disease dictionary in disease database and merges disease Sick dictionary carries out classification diagnosis, and diagnostic result is sent to doctor's advice management module；Doctor's advice management module, for establishing doctor's advice unit, cycle planning doctor's advice is formulated with reference to the diagnostic result and doctor's advice template, And establish cycle doctor's advice recording unit；Doctor's advice unit outside institute is established, short-term doctor's advice outside institute is formulated according to cycle planning doctor's advice, is started Cycle doctor's advice logging modle records order data outside institute and order data outside institute is sent to medical order compliance management module；Medical order compliance management module, for establishing assessment unit, carries out compliance assessment with reference to order data outside the institute, builds Vertical unit of intervening is sent to remote supervision module and condition assessment into the inner tube reason Data Concurrent that must leave hospital after compliance intervention in houses of prostitutes or actresses in the Jin and Yuan Dynasties Management module, establishes and is sent to remote supervision module after special element receives assessment result and intervenes unit；Remote supervision module, establishes remote management unit, and remote management unit is established with reference to compliance management data in the institute Into compliance intervention outside houses of prostitutes or actresses in the Jin and Yuan Dynasties, the outer tube that must leave hospital reason Data Concurrent, which is sent to the state of an illness, to be commented for query unit, reminding unit and feedback unit Estimate management module；Establish remote collaborative medical video unit and classification diagnosis and treatment examination ＆ verification unit realizes classification diagnosis and treatment and remote collaborative doctor Treat；Condition assessment management module, for establishing audit report unit and condition assessment unit, with reference to managing data outside the institute Regular condition assessment is carried out with data are managed in institute, system diagnostics module revision diagnosis and adjustment cycle are gone to according to assessment result Plan doctor's advice.
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| CN109603113A (en) * | 2018-12-24 | 2019-04-12 | 北京申润通科技有限公司 | A kind of slow sick exercise rehabilitation training method |
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| CN110517764B (en) * | 2019-08-28 | 2022-06-07 | 首都医科大学 | Telemedicine system and method for providing continuous coronary heart disease care |
| CN110517764A (en) * | 2019-08-28 | 2019-11-29 | 首都医科大学 | For providing the Telemedicine System and method of the nursing of coronary heart disease continuity |
| CN112037871A (en) * | 2020-08-12 | 2020-12-04 | 中南大学 | Grey correlation-based cloud medical advice service system for hemodialysis patients |
| CN112488858A (en) * | 2020-11-24 | 2021-03-12 | 泰康保险集团股份有限公司 | Chronic disease data management method and system |
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