基于“互联网+”医院-社区-家庭联动模式结核病患者随访方案的构建

doi:10.19982/j.issn.1000-6621.20230344

摘要/Abstract

摘要： 目的: 构建基于“互联网+”医院-社区-家庭联动模式的结核病患者随访方案。方法: 基于“Donabedian结构-过程-结果”理论,采用文献分析、半结构访谈初步拟定“互联网+”医院-社区-家庭联动模式的结核病患者随访方案。2023年1—7月,通过德尔菲法对30名专家进行函询,对指标进行增减和修改,确定最终方案。以最后一轮专家函询重要性评分均数差值作为Saaty评价尺度,采用层次分析法计算各指标权重。结果: 最终完成3轮德尔菲专家咨询,3轮函询问卷的有效回收率分别为90.0%(27/30)、92.6%(25/27)和92.0%(23/25),提建议率分别为59.3%(16/27)、24.0%(6/25)和8.7%(2/23),专家权威系数Cr值分别为0.87、0.91、0.92,变异系数分别为0.082~0.326、0.060~0.114、0~0.123,肯德尔和谐系数由0.058增至0.122,χ²检验P值均<0.01。最终形成的随访方案包括一级指标3项(医院-社区-家庭联动模块、健康宣教模块、评价模块),二级指标19项,三级指标47项,并确定了各指标权重,一级指标权重分别为0.387、0.443、0.170,CR值均<0.1。结论: 基于Donabedian理论构建的“互联网+”医院-社区-家庭联动模式的结核病患者随访方案具有科学性、可靠性、实用性和较好的临床价值,各指标权重量性化,一致性程度高,增加了方案的逻辑性,为结核病患者随访提供了标准化流程。

关键词: 结核, 计算机通信网络, 随访研究, 德尔菲技术

Abstract: Objective: To construct a follow-up plan for tuberculosis (TB) patients based on the “internet+” hospital-community-family linkage model. Methods: Drawing upon the “Donabedian structure-process-result” theory, a follow-up plan for TB patients was developed within the framework of the “internet+” hospital-community-family linkage model through comprehensive literature analysis and semi-structured interviews. Using Delphi method, 30 experts were consulted from January to July in 2023. The indicators were then modified to determine the final plan. The mean difference of importance scores from the last round of expert correspondence was used for the Saaty evaluation scale, and the weight for each index was calculated with the Analytic Hierarchy Process. Results: Three rounds of Delphi expert consultation were completed with effectively retrieve rates of 90.0% (27/30), 92.6% (25/27) and 92.0% (23/25), respectively, and the recommendation rates were 59.3% (16/27), 24.0% (6/25) and 8.7% (2/23), respectively. The Cr values of expert authority coefficients were 0.87, 0.91 and 0.92, respectively, and the coefficients of variation were 0.082-0.326, 0.060-0.114, 0-0.123, respectively. The Kendall’s coefficient of concordance (W) increased from 0.058 to 0.122, and the Chi-square tests were all P<0.01. The final index system included 3 first-level indicators (hospital-community-family linkage module, health education module, evaluation module), 19 second-level indicators, 47 third-level indicators, and the weight of each index was determined. The weights of the three first-level indicators were 0.387, 0.443, 0.170, respectively, all CR<0.1. Conclusion: Drawing upon the Donabedian theory, the “internet+” hospital-community-family linkage model of TB patient follow-up program is feasible, reliable, practical and of good clinical value. The weight of each indicator is quantized and the consistency is high, which increases the logic of the program and provides a standardized process for the follow-up of TB patients.

Key words: Tuberculosis, Computer communication networks, Follow-up studies, Delphi technique

中图分类号:

高丹, 王玲华, 黄金鹏, 郎雅珍. 基于“互联网+”医院-社区-家庭联动模式结核病患者随访方案的构建[J]. 中国防痨杂志, 2024, 46(2): 228-238. doi: 10.19982/j.issn.1000-6621.20230344

Gao Dan, Wang Linghua, Huang Jinpeng, Lang Yazhen. Construction of a tuberculosis patient follow-up program based on the “internet+” hospital-community-home linkage model[J]. Chinese Journal of Antituberculosis, 2024, 46(2): 228-238. doi: 10.19982/j.issn.1000-6621.20230344

图/表 5

参考文献 24

[1]	World Health Organization.Global tuberculosis report 2023. Geneva: World Health Organization, 2023.
[2]	阮淑金, 曾坚, 陈敬芳, 等. 结核病治疗依从性状况、影响因素及干预措施研究进展. 结核与肺部疾病杂志, 2023, 4(5): 419-424. doi:10.19983/j.issn.2096-8493.20230076.
[3]	Mulaku MN, Nyagol B, Owino EJ, et al. Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives. Glob Health Action, 2023, 16(1): 2148355. doi:10.1080/16549716.2022.2148355.
[4]	徐彩红, 赵雁林. 构建智慧化网络助力结核病防治. 中国防痨杂志, 2022, 44(3):215-218. doi:10.19982/j.issn.1000-6621.20210724.
[5]	Sekandi JN, Onuoha NA, Buregyeya E, et al. Using a Mobile Health Intervention (DOT Selfie) With Transfer of Social Bundle Incentives to Increase Treatment Adherence in Tuberculosis Patients in Uganda: Protocol for a Randomized Controlled Trial. JMIR Res Protoc, 2021, 10(1): e18029. doi:10.2196/18029.
[6]	李晓芬, 彭建明, 刘志东, 等. 采用《结核病防治手机一体化管理系统》进行微信转诊和随访的效果评价. 中国防痨杂志, 2020, 42(8):858-862. doi:10.3969/j.issn.1000-6621.2020.08.015.
[7]	Huang Q, Chen L, Aiqun J, et al. Effectiveness of the Hospital-Community-Family Nursing Model in Breast Cancer Patients Discharged with PICC Lines. J Community Health Nurs, 2023, 40(4): 255-265. doi:10.1080/07370016.2023.2205405.
[8]	王莉, 付阿丹, 黄艳, 等. “互联网+”医院-社区-家庭合作型护理服务模式的建立与实践. 中国护理管理, 2019, 19(11):1617-1621. doi:10.3969/j.issn.1672-1756.2019.11.005.
[9]	Chandru BA, Varma RP. Factors affecting ability of TB patients to follow treatment guidelines-applying a capability approach. Int J Equity Health, 2023, 22(1): 176. doi:10.1186/s12939-023-01991-7.
[10]	李源, 高风华, 金锋. DOTS联合微信管理方式对肺结核患者治疗管理效果的评价. 结核与肺部疾病杂志, 2021, 2(1):50-53. doi:10.3969/j.issn.2096-8493.2021.01.011.
[11]	Ayanian JZ, Markel H. Donabedian’s Lasting Framework for Health Care Quality. N Engl J Med, 2016, 375(3): 205-207. doi:10.1056/NEJMp1605101.
[12]	梅阳阳, 张琪, 林晓琼, 等. 以患者为中心的居家护理服务质量评价指标的构建. 中华护理杂志, 2021, 56(10):1533-1539. doi:10.3761/j.issn.0254-1769.2021.10.015.
[13]	Alipanah N, Jarlsberg L, Miller C, et al. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS Med, 2018, 15(7): e1002595. doi:10.1371/journal.pmed.1002595.
[14]	Ridho A, Alfian SD, van Boven JFM, et al. Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients with Tuberculosis: Systematic Review of Randomized Controlled Trials. J Med Internet Res, 2022, 24(2): e33062. doi:10.2196/33062.
[15]	刘萍萍, 林伟斌, 钟耐容, 等. 基于互联网微信平台的流动人口肺结核患者健康教育研究. 中国防痨杂志, 2017, 39(7):713-716. doi:10.3969/j.issn.1000-6621.2017.07.009.
[16]	吕霞. 基于“互联网+医院-社区-家庭”三元联动的炎症性肠病延续护理模式构建与初步应用. 南京: 东南大学, 2021. doi:10.27014/d.cnki.gdnau.2021.004186.
[17]	Conradie F, Diacon AH, Ngubane N, et al. Treatment of Highly Drug-Resistant Pulmonary Tuberculosis. N Engl J Med, 2020, 382(10): 893-902. doi:10.1056/NEJMoa1901814.
[18]	古力米娜·阿布力米提, 麦维兰江·阿不力米提, 地尔木拉提·吐逊, 等. 2021年喀什地区肺结核患者利福平耐药影响因素分析. 结核与肺部疾病杂志, 2022, 3(4):269-273. doi:10.19983/j.issn.2096-8493.20220094.
[19]	Monique O, Ilse DP. Factors contributing to pulmonary tb treatment lost to follow-up in developing countries: an overview. Afr J Infect Dis, 2022, 17(1): 60-73. doi:10.21010/Ajidv17i1.6.
[20]	何梦雪, 陆红, 沈南平, 等. 儿童血液肿瘤护理质量指标体系的构建. 中华护理杂志, 2018, 53(8):950-955. doi:10.3761/j.issn.0254-1769.2018.08.010.
[21]	Tossaint-Schoenmakers R, Versluis A, Chavannes N, et al. The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome. J Med Internet Res, 2021, 23(5): e27180. doi:10.2196/27180.
[22]	Koo HK, Min J, Kim HW, et al. Prediction of treatment failure and compliance in patients with tuberculosis. BMC Infect Dis, 2020, 20(1): 622. doi:10.1186/s12879-020-05350-7.
[23]	Fanghua G, Sanhui T. Internet Intervention System for Elderly Hypertensive Patients Based on Hospital Community Family Edge Network and Personal Medical Resources Optimization. J Med Syst, 2020, 44(5): 95. doi:10.1007/s10916-020-01554-1. URL pmid: 32193696
[24]	Needamangalam Balaji J, Prakash S, Park Y, et al. A Scoping Review on Accentuating the Pragmatism in the Implication of Mobile Health (mHealth) Technology for Tuberculosis Management in India. J Pers Med, 2022, 12(10): 1599. doi:10.3390/jpm12101599.