JP2002297779A - Method for supporting creation of rehabilitation plan and execution computer program therefor - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a method for supporting the creation of a rehabilitation plan suitable for each patient. SOLUTION: Each of plural items composing a course of a rehabilitation plan and at least one patient information related to each item are corresponded to each other, and a computer program determines whether the corresponding item should is necessary to be put in the rehabilitation plan or not, according to the contents of the patient information. Therefore, according to symptoms and a life condition of the patient, necessary items are automatically selected, and a course curriculum of the rehabilitation plan is structured, so that a rehabilitation plan suitable for each patient can be easily created.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a method for supporting the preparation of a rehabilitation plan implemented in a hospital for a patient having a disease or an injury, and a computer program for implementing the method. The rehabilitation plan is a respiratory rehabilitation plan especially for patients having a pulmonary disease such as chronic respiratory failure.

[0002]

2. Description of the Related Art Home therapy for patients with pulmonary diseases such as chronic respiratory failure is known. Home therapy is a therapy that continues treatment at home while going to the hospital regularly,
For example, there are drug therapy for taking a drug, nutrition therapy for managing nutrition at meals and the like, oxygen therapy for sucking oxygen, and exercise therapy for exercise such as walking. In particular, in home oxygen therapy (HOT), an oxygen concentrator is installed in a patient's home so that the patient can perform treatment while living in a familiar environment without hospitalization. Became. However, when performing home therapy, a patient needs to be hospitalized or visited for a certain period (for example, about 7 to 10 days) and take a respiratory rehabilitation plan.

[0003] The respiratory rehabilitation plan provides patients with pulmonary diseases such as chronic respiratory failure with (1) understanding of diseases and acceptance of disorders (2) correct understanding of treatment methods including medication and oxygen inhalation (3) ) Learning to breathe without breathlessness and restoring residual function (4) Utilization of social resources (5) This curriculum is implemented at medical institutions to improve self-management ability. By performing this for a patient, the medical institution can motivate the patient to reintegrate into the society and promote treatment at home.

[0004] A respiratory rehabilitation plan is prepared by combining medical examination, treatment, treatment, examination, training, exercise therapy, physical therapy, and the like. The course is
Includes education and guidance to deepen understanding of the disease and home therapy, and training in the use of breathing methods and oxygen concentrators (when performing oxygen therapy).

[0005] In particular, training in a respiratory rehabilitation plan requires individuality, but conventionally, a uniform curriculum has been provided for all patients, or the curriculum required for each patient is the individual's curriculum. It depends on the treatment method prescribed by the doctor according to the degree of the disease and the living environment. For example, the coordinator determines over a long period of time that no education on smoking is necessary for a patient who does not have a smoking habit.

[0006]

SUMMARY OF THE INVENTION An object of the present invention is to provide a method for supporting the creation of an optimal rehabilitation plan for each patient, and a computer program for implementing the method.

[0007]

A rehabilitation plan creation support method according to the present invention for achieving the above object is provided by the following.
In a method for supporting the creation of a rehabilitation plan that is implemented for a patient and includes a course composed of a plurality of subjects related to rehabilitation, the system accepts input of a plurality of patient information related to the symptoms and living conditions of the patient, and for each subject, It is characterized in that it is determined whether or not each subject is to be incorporated into a rehabilitation plan, based on at least one piece of input patient information associated with the subject.

[0008] According to the present method, an optimal subject for each patient is automatically selected, and an optimal rehabilitation plan can be easily created for each patient.

[0009]

Embodiments of the present invention will be described below. However, the technical scope of the present invention is not limited to the present embodiment. In the present embodiment, a respiratory rehabilitation plan for a patient having a lung disease will be described as an example of the rehabilitation plan.

[0010] The respiratory rehabilitation plan creation support method in the embodiment of the present invention is preferably realized as a computer program (respiratory rehabilitation plan creation support program) executed by a personal computer. In this computer program, a plurality of items relating to the degree of a disease and a living condition of a patient are input, and the creation of an optimal respiratory rehabilitation plan is supported according to the input data.

The respiratory rehabilitation plan is composed of a combination of a doctor's examination, various tests (such as blood tests), training for education and training, ADL training, strength training, walking training, and breathing training. In the present embodiment, an example in which a curriculum of a course in a respiratory rehabilitation plan is optimally configured will be described below.

Subjects (1) to (1) constituting a course in a respiratory rehabilitation plan according to an embodiment of the present invention.
(12) will be exemplified, and the purpose and contents of each item will be briefly described. In each course, as needed, lectures using textbooks and video teaching materials, and training and practice using actual equipment (oxygen concentrator, portable oxygen cylinder, etc. when oxygen therapy is performed) Done.

(0) Before Participating in the Program Clarify what the purpose is to participate in the respiratory rehabilitation plan. QOL (Quality of Life) to objectively determine the effect of a respiratory rehabilitation plan
Also assess mental status.

(1) Introduction The purpose of participation in the respiratory rehabilitation plan is correctly communicated, and the contents of future programs will be described.

(2) Anatomy basics-1: Pulmonary physiology and pathology Promote correct understanding of respiratory diseases and provide guidance on the need for oxygen.

(3) Basics of anatomy-2: Physiology and examination of respiration Learning the function of respiratory muscles and promoting the usefulness of abdominal respiration and pursed-mouth respiration.

(4) Breathing training and its application to movements ADL (Activity of Dai
ly Life). Guidance with practical skills on pursed-mouth breathing, abdominal breathing in each position, panic control breathing, respiratory assistance by family members, respiratory muscle stretching exercises, and respiratory muscle training. Guidance and training so that it can be performed without a leader through repeated training in the physiotherapy room.

(5) Drug Therapy Promote correct understanding of drugs used for the treatment of respiratory diseases and provide guidance so that medication can be managed. Understand that medication treatment is an important pillar of respiratory rehabilitation.

(6) Oxygen Therapy Understand the home oxygen therapy correctly, and teach the necessity of oxygen inhalation and the handling of the oxygen supply device. Furthermore, they will deepen their understanding of available welfare services and travel services, and lead them to perform home oxygen therapy while maintaining a high QOL. Furthermore, at the time of guidance, an actual oxygen concentrator and a portable oxygen cylinder are arranged, and the handling and the like are explained in real terms.

(7) For a more comfortable recuperative life: daily care and ingenuity The patient's independence is explained by explaining the patient's symptoms and feelings to the patient's family and other related persons. Understand the need for cooperation. In addition, when going out according to the season,
We recommend that you provide a more comfortable medical treatment environment through advice such as how to devise a housing suitable for your illness and guidance in your daily life.

(8) Prevention of infection In the case of chronic respiratory disease, infection often triggers acute exacerbations. Guidance for gargle and hand-washing to prevent daily infection. In consultation with the attending physician, guidance will be given on influenza vaccination. In addition, instruct patients who have a high volume of sputum about the position of sputum.

(9) Preparing for acute exacerbation Instructions on how to deal with acute exacerbation caused by infections such as colds and water control are not possible. It provides guidance on taking medication when a sign of acute exacerbation is detected and how to consult a hospital, prevents exacerbation of exacerbation by selfish judgment, and provides guidelines for early improvement.

(10) Smoking cessation Tobacco is one of the major causes of chronic respiratory illness, and the risk of fire to oxygen is high for patients undergoing home oxygen therapy. Is recognized purely. Also, ask people around the patient to be convinced of smoking cessation around the patient.

(11) Diet for people with chronic respiratory failure In the case of chronic respiratory illness, considerable energy is expended in breathing, and physical strength decreases with weight loss. We will teach you to eat a balanced diet to control this weight loss and ensure a high ADL. Also, aim to know your standard weight and get closer to it. Instruct patients who have difficulty eating a high calorie supplement.

(12) Exercise for You Even if you have shortness of breath, exercise continuity within the possible range will increase your exercise tolerance. Instruct students to prevent being bedridden by moderate exercise load. In addition, the work of the heart improves by moderate exercise,
Make them understand that their dyspnea is reduced.

The respiratory rehabilitation plan creation support program according to the embodiment of the present invention selects an optimal subject from such subjects according to the patient's symptoms and living conditions, and supports creation of a respiratory rehabilitation plan.

The processing of the respiratory rehabilitation plan creation support program according to the embodiment of the present invention will be described.

FIG. 1 shows a respiratory rehabilitation plan creation support program (hereinafter, referred to as an embodiment) according to the embodiment of the present invention.
FIG. 7 is a diagram illustrating an example of patient information necessary for executing a creation support program). The patient information in FIG.
It is displayed as a patient information input screen (title: Comprehensive Rehabilitation Plan Participant Initial Evaluation Table) as shown in FIG. 1 on the screen of the computer that executes the creation support program. The user operates the computer to input patient information such as the patient's symptoms and living conditions.

The patient information is personal information of each patient (items such as the patient's name, ID, age, gender, address, family structure, etc.).
And measurement data information (items such as lung function, blood gas, 6MD evaluation, shortness of breath, mental condition, etc.) by various tests, and information on symptoms and living conditions (cough, sputum, wheezing, swallowing, other organ diseases, nutritional status, ADL, self-care, smoking, disease knowledge, medication compliance, oxygen compliance, etc.). The user (mainly a doctor) directly inputs predetermined items such as the patient's name, ID, age, and address, but a plurality of options displayed in advance as a pull-down menu are given to other items. The user enters patient information by selecting one option that best matches the patient's condition.

By pressing a predetermined execution key after inputting necessary patient information, the creation support program according to the present embodiment executes a process of selecting an item required for the patient from the plurality of items. I do. More specifically, the creation support program of the present embodiment associates each of a plurality of subjects of the respiratory rehabilitation plan with at least one piece of patient information related to each subject, and responds according to the contents of the patient information. To determine if it is necessary to incorporate the subject into the respiratory rehabilitation plan. In addition, in the above-mentioned respiratory rehabilitation plan, subject (0) “Before participating in the program”, subject (1)
“Introduction” applies to all patients who implement a respiratory rehabilitation plan, regardless of patient information.

FIG. 2 is a diagram for explaining the criteria for each item. In FIG. 2, for example, the subject (2) “Basic Anatomy-1: Lung Physiology and Pathology” is associated with the item “disease knowledge” a in the patient information in FIG. This is to determine the inclusion of the item (2) for instructing the basic knowledge of the lung according to the degree of understanding of the lung disease. The item “disease knowledge” includes, for example, the following pull-down menus (options).

・ Good (primary score 1) ・ Somewhat inadequate self-management (primary score 2) ・ Unable to control the medical condition (primary score 3) ・ Depends on others (primary score 4) Points are given, and the raw score is set such that the higher the score, the greater the degree of lack of knowledge.

Then, a total value obtained by multiplying the raw point of the selected option by a weight value (“2”) given in advance is obtained, and the sum is compared with a threshold value (“8”) given in advance. .

If the sum is greater than or equal to the threshold, the item is included in the respiratory rehabilitation plan; if it is less than the threshold, it is not included. Therefore, in the subject “(2) Basics of Anatomy-1: Physiology and Pathology of Lung”, the threshold value is “8”, the weight value is “2”, and the score 4 in the item “disease knowledge” is set. If the option (2) is selected, the item (2) is incorporated into the respiratory rehabilitation plan. In FIG. 2, the determination value for the case of being incorporated is defined as “1”, and the determination value for the case of not being incorporated is defined as “0”. Note that the weight value and the threshold value can be changed, and the raw score can also be changed. By changing the threshold value, the weight value, and the raw score, the condition for incorporating the item can be freely changed.

The number of items associated with each item may not be one. For example, in the case of the subject (1), in addition to the item “disease knowledge”, another item (for example, “other organ disease” or the like) may be associated. At this time, the weighting value of each item may be set to be different depending on the degree of association of each item with the item. In addition, a threshold value is also set for a total value of each raw score × each weight value in a plurality of items associated with one item. When one item is associated with each item, the weight value does not need to be set (or the weight value is “1”).

Next, the subject (3) “Basic Anatomy-2: Physiology and Examination of Respiration” is associated with the item “pulmonary function% VC” or “pulmonary function FEV1%” b in the patient information of FIG. Can be
The item “pulmonary function% VC” or “pulmonary function FEV1%” is information on vital capacity, and it is determined by this item whether or not an item (3) that provides guidance on respiration is incorporated according to the degree of vital capacity. be able to. Item "Lung function% VC"
Alternatively, “pulmonary function FEV 1%” has, for example, the following pull-down menu (options).

80% or more of predicted value (primary point 1) 70-80% of predicted value (primary point 2) 60-70% of predicted value (primary point 3) 50-60% of predicted value (primary point 3) Elementary point 4)-Less than 50% of the predicted value (elementary point 5) The elementary point is set so that the larger the elementary point is, the smaller the actual vital capacity is with respect to the predicted vital capacity. Also in this case, the inclusion of the item (3) is determined based on the comparison between the total value (the raw score × the weighted value) and the threshold value, as described above. In the following, for items (4) to (12), the corresponding items and their options are described. Similarly to the above, the total value in each item is compared with each threshold value, and the threshold value is determined according to the magnitude. Incorporation of each item is determined.

Subject (4) “Respiration training and application to movement”
Is the item "ADL (Activ
ity of Daily Life) ". Item "AD
L "c includes, for example, the following options.

No restrictions are imposed (primary point 1) ADL of the routine is OK, walking is possible for 1 km (primary point 2) Remarkable restriction on ADL, shortness of breath at a short distance (primary point 3) Movement is wheelchair Item (5) “Pharmatherapy” is associated with an item “drug compliance” d that indicates whether or not the drug is taken as instructed by the doctor. The item “medication compliance” includes, for example, the following options.

・ Can be performed correctly (primary score 1) ・ Make mistakes sometimes (primary score 2) ・ Make mistakes frequently and need guidance (primary score 3) ・ I cannot judge by myself (primary score 4) Subject (6) “Oxygen therapy” Is associated with an item “oxygen compliance” e indicating whether oxygen inhalation is performed as instructed by the doctor. The item “oxygen compliance” includes, for example, the following options.

・ Comply with prescription (primary point 1) ・ Inhalation time is short and flow rate is unstable (primary point 2) ・ Inhalation time is extremely short and flow rate is changed (primary point 3) ・ Inhalation is hardly observed (primary point 4) The item (7) “For a more comfortable recuperative life ... everyday care and ingenuity” is associated with the item “Borg scale” f representing the degree of shortness of breath. The item “Borg scale”
For example, the following options are provided.

0 degrees (primary point 1) 1-3 degrees (primary point 2) 4-6 degrees (primary point 3) 7-9 degrees (primary point 4) 10 degrees (primary point 5) The item (8) “Prevention of infection” is associated with the item “cough” g representing the degree of cough of the patient. The item "cough"
For example, the following options are provided.

No coughing (primary score 1) ADL has trouble with ADL only in the morning (primary score 2) Daytime, limited ADL (primary score 3) Dizziness due to cough, fainting (primary score 4) The item (9) “Preparing for acute exacerbation” is associated with the item “sputum” h that reduces the degree of sputum. The item "sputum"
For example, the following options are provided.

None (primary score 1) Mainly only in the morning, 50 cc or less (primary score 2) 50-100 cc, usually transparent (primary score 3) Large and colored sputum (primary score 4) Item (10) ) "No smoking" is associated with the item "smoking" i. The item “smoking” includes, for example, the following options.

・ No experience (primary score 1) ・ No smoking more than a year ago (primary score 2) ・ No smoking 6 months ago (primary score 3) ・ Recent smoking cessation (primary score 4) ・ About 10 bottles / day Smoking (primary score 5)-About 20 cigarettes / day smoking (primary score 6) Item (11) "Diet for people with chronic respiratory failure" is an item that represents the degree of weight corresponding to the nutritional status of the patient. Nutrition status "j. The item “nutrition status” includes, for example, the following items.

-Above standard weight (primary score 1)-Slightly below standard weight (primary score 2)-Under 20% below standard weight (primary score 3)-Under 20% or more below standard weight (primary score 4) (12) “Let's do exercise that suits you” is associated with the item “SpO2 (arterial blood oxygen saturation)” k. The item “SpO2” includes, for example, the following options.

95% or more (score 1) 92-95% (score 2) 88-92% (score 3) 85-88% (score 4) 85% or less (score 5) As described above, the degree of at least one input item related to each item determines the incorporation of the item into the respiratory rehabilitation plan. That is, only the items having the determination value of “1” are included in the respiratory rehabilitation plan. In FIG. 2, items other than items (10) and (11) are selected.

Therefore, necessary subjects are automatically selected in accordance with the symptoms and living conditions of each patient, and a training curriculum for a respiratory rehabilitation plan is constructed. Therefore, an optimal respiratory rehabilitation plan for each patient can be easily created. Will be able to

The total of the total points of each item (total points)
(Reference numeral m in FIG. 1) is a predetermined value (for example, 150
(Point) and only patients whose values are equal to or greater than a predetermined value may be allowed to participate in this respiratory rehabilitation plan. The total score is the sum of the raw scores of all the items including the items that do not correspond to each item (or the total of the raw scores × weights).

FIG. 3 is a diagram showing an example of a respiratory rehabilitation plan. FIG. 3 shows an example of a respiratory rehabilitation plan that combines examination by a doctor, examination, and a training curriculum created as described above. Items (10) and (11) not selected in the above processing are:
Not included. Also. The items selected as described above need not be performed in order (however, item (0)
“Before participating in the program” and item (1) “Introduction” are performed first in the order of item (0) and item (1)). Preferably, the most efficient curriculum is set in consideration of the convenience of the department in charge of each subject.
For example, the department in charge of the subject (5) “medicine therapy” is a pharmacy department in a hospital, and the department in charge of the subject (4) “application to respiratory training and movement” is a rehabilitation center.

In order to set an efficient curriculum, the schedule of each department in charge is input in advance to the creation support program, and the creation support program allocates the assigned subject to a vacant time zone of each department in charge. Processing may be performed.

In addition, if there is an item related to a medical examination and examination by a doctor, and it is necessary to carry out the relevant item before the medical examination (or after the medical examination) and before the medical examination (after the medical examination), it is necessary to schedule the medical examination and the medical examination by the medical doctor. By inputting into the creation support program, the subject may be assigned before the examination (or after the examination) and before the examination (or after the examination) so as to meet the condition.

As a result, the number of days of hospitalization or the number of hospital visits of the patient can be shortened while the efficiency of the rehabilitation plan is improved, and high-quality and efficient medical care can be provided.

The above-described embodiment is not limited to a respiratory rehabilitation plan for a patient having a pulmonary disease, but is also applicable to a predetermined rehabilitation plan for a patient having another disease or injury.

(Supplementary Note 1) In a method for supporting the creation of a rehabilitation plan that is implemented for a patient and includes a course composed of a plurality of subjects related to rehabilitation, an input of a plurality of patient information on a patient's symptoms and living conditions is received. For each item, based on at least one input patient information associated with each item,
A rehabilitation plan creation support method, characterized in that it is determined whether or not each subject is incorporated into a rehabilitation plan.

(Supplementary Note 2) In Supplementary Note 1, each patient information has a plurality of options that are previously scored, and for at least one piece of patient information corresponding to each item, the score of the option selected by input or the score of the option. A rehabilitation plan creation support method, comprising: determining whether to incorporate each item into a rehabilitation plan, based on a comparison between a sum of values multiplied by a predetermined weighting value and a predetermined threshold.

(Supplementary Note 3) The rehabilitation plan creation support method according to Supplementary note 1 or 2, wherein a training curriculum of a plurality of courses incorporated by the judgment is created according to the schedule of a department in charge of each course.

(Supplementary note 4) In any one of Supplementary notes 1 to 3, the rehabilitation plan includes a plurality of courses incorporated by the judgment, a medical examination by a doctor, a predetermined examination, and a plurality of courses incorporated by the judgment. A rehabilitation plan creation support method, wherein the curriculum is created according to the schedule of a medical examination and / or a predetermined examination by a doctor.

(Supplementary note 5) The rehabilitation plan creation support method according to any one of Supplementary notes 1 to 4, wherein the rehabilitation plan is a respiratory rehabilitation plan implemented for a patient with a lung disease.

(Supplementary Note 6) In a computer program for supporting the preparation of a rehabilitation plan including a course composed of a plurality of subjects related to rehabilitation, which is implemented for a patient, a plurality of patient information items relating to the patient's symptoms and living conditions are provided. A computer program for determining whether to incorporate each item into a rehabilitation plan based on at least one input patient information associated with each item.

(Supplementary Note 7) In Supplementary Note 6, each patient information has a plurality of options that are previously scored, and for at least one piece of patient information corresponding to each item, the score of the option selected by input or the A computer program for determining whether to incorporate each item into a rehabilitation plan, based on a comparison between a sum of values multiplied by a predetermined weighting value and a predetermined threshold.

(Supplementary note 8) A computer program according to Supplementary note 6 or 7, wherein a training curriculum of a plurality of courses incorporated by the judgment is created according to a schedule of a department in charge of each course.

(Supplementary note 9) In any one of Supplementary notes 6 to 8, the rehabilitation plan includes a plurality of courses incorporated by the judgment, a medical examination by a doctor, a predetermined examination, and a plurality of courses incorporated by the judgment. A computer program for preparing a curriculum according to a schedule of a medical examination and / or a predetermined examination by a doctor.

(Supplementary note 10) The computer program according to any one of Supplementary notes 6 to 9, wherein the rehabilitation plan is a respiratory rehabilitation plan implemented for a patient with a lung disease.

(Supplementary Note 11) In a system for supporting the preparation of a rehabilitation plan which is implemented for a patient and includes a course composed of a plurality of courses relating to rehabilitation, an input means for inputting a plurality of patient information relating to the symptoms and living conditions of the patient Rehabilitation plan creation, characterized by comprising, for each subject, determining means for determining whether or not to incorporate each subject into the rehabilitation plan based on at least one input patient information associated with each subject. Support system.

(Supplementary Note 12) In Supplementary Note 11, each patient information has a plurality of options that have been scored in advance, and the determination unit has selected by inputting at least one patient information corresponding to each item. Creating a rehabilitation plan based on a comparison between a score of options or a sum of values multiplied by a predetermined weighting value and a predetermined threshold value, and determining whether to incorporate each item into the rehabilitation plan; Support system.

(Supplementary Note 13) In Supplementary note 11 or 12,
A rehabilitation plan creation support system, wherein a training curriculum of a plurality of courses incorporated by the determination is created according to a schedule of a department in charge of each course.

(Supplementary note 14) In any one of Supplementary notes 11 to 13, the rehabilitation plan includes a plurality of courses incorporated by the judgment, a medical examination by a doctor, a predetermined examination, and a plurality of courses incorporated by the judgment. A rehabilitation plan creation support system, which creates a curriculum according to a schedule of a medical examination and / or a predetermined examination by a doctor.

(Supplementary note 15) The rehabilitation plan creation support system according to any one of Supplementary notes 11 to 14, wherein the rehabilitation plan is a respiratory rehabilitation plan implemented for a patient with a lung disease.

The scope of protection of the present invention is not limited to the above embodiments, but extends to the inventions described in the claims and their equivalents.

[0071]

As described above, according to the present invention, necessary subjects are automatically selected according to the symptoms and living conditions of each patient.
Since the training curriculum of the rehabilitation plan is configured, it is possible to easily create an optimal rehabilitation plan for each patient.

[Brief description of the drawings]

FIG. 1 is a diagram showing an example of patient information necessary for executing a respiratory rehabilitation plan creation support program according to an embodiment of the present invention.

FIG. 2 is a diagram for explaining criteria for each item.

FIG. 3 is a diagram showing an example of a respiratory rehabilitation plan.

[Explanation of symbols]

a, b, c, d, e, f, g, h, i, j, k Item of patient information m Total score

Claims (2)

[Claims] Claims: 1. A method for supporting the preparation of a rehabilitation plan, which is performed on a patient and includes a course composed of a plurality of subjects related to rehabilitation, receives input of a plurality of patient information relating to symptoms and living conditions of the patient. A rehabilitation plan creation support method, characterized in that it is determined whether or not each item is to be incorporated into a rehabilitation plan, based on at least one input patient information associated with each item. 2. A computer program for supporting the creation of a rehabilitation plan that is implemented for a patient and includes a course composed of a plurality of subjects related to rehabilitation, comprising: inputting a plurality of patient information relating to symptoms and living conditions of the patient. A computer program for determining whether to incorporate each item into a rehabilitation plan based on at least one input patient information associated with each item.