基于App的日间手术围术期远程管理模式的构建

Day surgery has been shown to be economical and efficient, it can maximally reduce the cost of medicine, which benefits medical staff，patients and society. In Europe and America, it is stated that 80% of all elective surgery should be undertaken on a day surgery basis. However，only about 20% elective surgery in our country are day surgery which is hard to expand in China, due to unbalanced development of medical resource which cannot provide the sufficient support to day surgery. Insufficient preparation is always existed in preoperative period, and lacking of monitoring and instruction postoperatively. Therefore, the patients need urgently the multidisciplinary, professional medical service model, which can be extended to preoperative and postoperative periods. The program combines the experience of our pilot study ‘Application of information platform to management of outpatient’ and the advantages of computer and medicine, as well as theories of those disciplines. We will construct the new management model for day surgery based on application of mobile phone and evaluate its effect. Firstly, we will analyze the requirement of medical staff and patients, and then explore the application based on the theories of “Orem self-care model” and “information- motivation-behavioral skills (IMB) model”. By taking advantages of this model, we suppose to achieve the peri-operative individualized and interactive management for patients undergoing day surgery. The aim of this study was to investigate whether the new model can reduce the rate of cancellation and non-scheduled re-admission, besides, whether it can relief anxiety and pain, or reduce the incidence of wound infection and other complications, or promote the fast recovery, or reduce the cost and ensure the peri-operative safety. The new model has obvious economic and social value.

日间手术能最大限度地减少医疗费用，兼顾医、患及社会等多方利益，在欧美发达国家约占择期手术的80%，而我国仅为20%左右。我国医疗资源发展不均衡，日间手术的推广缺乏有效的支撑，患者存在术前准备不充分，术后康复缺乏监管等问题，迫切需要一种多学科组成、专业 、能够向前延伸至术前、向后延伸至家庭的医疗服务模式。本项目组结合前期研究“基于信息平台对门诊患者管理”的实践经验，综合计算机和医学的优势及学科理论，构建基于智能终端应用程序（App）的日间手术围术期远程管理模式并评价其效果。在充分分析用户需求的基础上，以“Orem自理模式”和“信息-动机-行为技巧模式”理论为指导开发App，借助此款App对患者围术期进行个体化、交互式管理。以期达到降低手术临时取消率、术后非计划再入院率；缓解焦虑、术后疼痛、降低伤口感染等并发症发生率；促进快速康复，降低医疗费用，保障围术期安全的目的，有明显的经济和社会价值

日间手术术后管理一直是医疗服务的一个盲区，现有的医疗服务不能满足日间手术患者日益增长的需求。因此迫切的需要建立一个适合我国国情的、多学科参与的、向术前、术后延伸的日间手术远程管理模式。研究分为两步，第一步，了解用户需求，调查医患双方在围术期的不同需求及关注点。调查发现99.6%的医护人员愿意使用App对患者进行围术期管理，其关注的重点为：术前准备、术后康复及麻醉相关信息。88.2%的患者愿意使用App进行围术期的自我管理。其关注的重点集中在麻醉及术后康复。研究的第二步，在第一步研究的基础上设计该App，并在部分日间手术患者中，将该系统和传统电话随访管理模式进行比较，研究发现实验组患者因术前准备不充分被停手术的概率比对照组降低1.35%， 0.60（042，0.87）。且降低了术后一月的非计划再入院率，5.6% vs 9.2%, P=0.032; 降低了患者术后第二天的疼痛评分 2.3±0.9 vs 3.2±1.2，P=0.04; 以及术后1周的焦虑评分2.5±0.7 vs 4.6±0.9，P=0.022；术后恢复质量量表显示该模式能促进患者的康复，术后1周，新模式组有96%的患者感到整体状态良好，而传统模式组有92%的患者感到整体状态良好，P=0.033, 差别有统计学意义。而就医患双方的满意度而言，95%的医护人员对该系统表示非常满意，认为该系统降低了他们的工作量，有88%的患者对该系统表示非常满意，认为该系统提供的信息具有针对性，能满足他们的信息需求。有76%的患者坚持完成了术后一周的自动评估。综上，本研究构建的基于App的日间手术患者围术期远程管理新模式，和传统的日间手术管理模式相比，该模式以患者为中心，满足患者个体化需求，做到了有的放矢，让信息的传递更具针对性，重视医患双方的互动，打造真正意义上的远程医疗，增强了医疗资源的利用度和医患双方的满意度。