Email Alert | RSS    帮助

中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (7): 676-681.doi: 10.3969/j.issn.1000-6621.2020.07.007

• 新技术·方法 • 上一篇    下一篇

宁夏地区“互联网+医疗”模式在结核病防治工作中的应用

刘广天, 刘涛, 王晓炜, 雷娟, 田晓梅, 王晓林()   

  1. 750021 银川,宁夏回族自治区第四人民医院 宁夏结核病防治所防治科
  • 收稿日期:2020-05-17 出版日期:2020-07-10 发布日期:2020-07-09
  • 通信作者: 王晓林 E-mail:wxldyj9662@163.com
  • 基金资助:
    中华人民共和国国家卫生健康委员会-比尔及梅琳达·盖茨基金会结核病防治合作项目(OPP1137180);宁夏回族自治区重点研发计划项目(2018BEE03032)

Application of “Internet+Medical Treatment” model in tuberculosis prevention and treatment in Ningxia

LIU Guang-tian, LIU Tao, WANG Xiao-wei, LEI Juan, TIAN Xiao-mei, WANG Xiao-lin()   

  1. Tuberculosis Prevention and Treatment Department of Ningxia Tuberculosis Dispensary, the Fourth People’s Hospital of Ningxia Autonomous Region, Yinchuan 750021,China
  • Received:2020-05-17 Online:2020-07-10 Published:2020-07-09
  • Contact: WANG Xiao-lin E-mail:wxldyj9662@163.com

摘要:

2019年初,宁夏回族自治区搭建起有效整合结核病定点医疗机构、疾病预防控制中心、基层医疗卫生机构等各医疗卫生业务的《宁夏结核病防治管理信息系统》,以患者就诊时间为轴线形成包含患者个人基本信息、疾病史、历次诊疗资料及费用等共计530余项信息的电子病历,并可将患者的基本信息、体检筛查、疾病史等91项内容自动上传至中国疾病预防控制中心的《新型结核病监测系统》。截止到2019年底,该系统已与宁夏地区19家结核病定点医院的医院信息系统(HIS系统)相链接,占全区定点医院总数的95.00%(19/20);2019年全年共计抓取符合条件的疑似结核病患者3258例,高于《传染病监测系统》报告的2445例患者,匹配患者占《传染病监测系统》提取患者的85.6%(2093/2495)。截至2020年5月,43家医疗机构安装了人工智能影像系统,共计筛查可疑患者3639例,987例疑似结核病患者的确诊率高达43.87%(433例);随机从3639例可疑患者正位胸片中提取100张,以放射科专家阅片结果为标准,智能影像系统的判定敏感度为90.91%(10/11)、特异度为89.89%(80/89),Kappa值为0.61(0.60~0.62),有效提高了医疗效率和诊断效能。截止到2020年5月已注册医务人员2130余名,有效随访例次率达61.78%(1125/1821);随机从系统中抽取98例安装手机同步应用程序的普通肺结核患者和76例未安装手机同步应用程序的患者,发现前6个月的平均服药率前者[96.93%(15396/15883)]明显高于后者[92.99%(11411/12271)](χ2=236.17,P=0.000),患者服药依从性明显提高。

关键词: 结核, 疾病管理, 集成高级信息管理系统, 结果评价(卫生保健)

Abstract:

At the beginning of 2019, Ningxia Autonomous Region has set up the “Information System for Ningxia Tuberculosis Prevention and Treatment Management”, which effectively integrated the technical work of the tuberculosis (TB) designated medical institutions, the disease prevention and control centers, the grass-roots health care institutions and other health service facilities. In this information system, with the patient’s treatment timeline as the axis, an electronic medical record, which contains more than 530 information items, is formed for each patient, including the patient’s basic personal information, disease history, previous diagnosis and treatment results and cost information, etc. Among those information items, 91 items (e.g. the patient’s basic information, physical examination and screening results and disease history, etc.) can be automatically transferred to the National New TB Monitoring System managed by the Chinese Center for Disease Control and Prevention. By the end of 2019, the Ningxia TB Prevention and Treatment Management Information System has been linked with the 19 designated TB hospitals’ information system (HIS system) in Ningxia, accounting for 95.00% (19/20) of the total number of the TB designated hospitals in the whole region; in 2019, a total of 3258 TB suspects, who were eligible, were captured by this information system, while 2445 TB patients were reported in the “infectious disease surveillance system” and 85.60% (2093/2445) of the reported patients came form the captured TB suspects. As of May 2020, 43 medical institutions have installed the artificial intelligence (AI) image system and 3639 persons with TB symptoms got screening, then 987 TB suspects were detected and 433 cases were confirmed as TB, the diagnosis rate was 43.87% (433/987). 100 chest films of the 3639 persons with TB symptoms were randomly extracted and read by the radiologists. Based on the radiologists’ reading results, the sensitivity and specificity of the AI image system were 90.91% (10/11) and 89.89% (80/89) respectively, the Kappa value was 0.61 (0.60-0.62), which effectively improved the medical service efficiency. As of May 2020, more than 2130 health staff have registered in this information system with an effective follow-up rate of 61.78% (1125/1821) to the patients under treatment; 28 patients with pulmonary TB who installed smart phone sync APP and 33 patients who did not install sync cell-phone APP were randomly selected from the information system, and the average treatment adherence rate at the first six months of treatment in the patients using sync APP was 96.93% (15396/15883), which was significantly higher than that in the patients without using sync APP (92.99% (11411/12271))](χ 2=236.17, P=0.000), the treatment adherence of the patients was significantly improved.

Key words: Tuberculosis, Disease management, Integrated advanced information management systems, Outcome assessment (health care)