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