医患共建平行病历体现中医临床真实疗效的整体评价方法构建

Value orientation of patients is among the three elements of the evidence-based medicine, the parallel medical record of narrative medical science is a record which focuses more on the subjective indisposition and their treating experience. It is an urgent problem for us to solve that by which way shall we complete the assessment of real efficacy of TCM through Physician-patient codetermination. Reach group has proposed the concept of Physician-patient co-constructing parallel medical record and made the method exploration on digestive disease in the previous National Natural Science Foundation of China. In what way our evaluating method can be more objective and exercisable, in this text we plan to optimize the overall evaluation methodology for the treatment of pre-gastric carcinoma with TCM, by the utilization of Structural Equation Models(SEM) and Analytic Hierarchy Process(AHP).Through the clinical specialistic Delphic and consensus meeting methods, the index such as the determination of living emotional scores for patients, inform of ending for patients, symptoms evaluation integral by doctors, gastroscope after 1-3 years and pathological score as well ,are made ,and the hierarchical structure are established as judgment matrix items. And combined with experts consensus and analytic hierarchy process (AHP),we calculated weight and consistency check.And then the structural equation model is made on therapeutic evaluation of Physician-patient parallel medical record specifically in pre-gastric carcinoma lesions through SEM, realizing the visualization and traceability for the overall evaluation . This study will reinforce the Physician-patient communications and enhancing their mutual trust , affording new thought and new method for improving the general evaluation on real efficacy of TCM .

患者价值取向是循证医学三要素之一，叙事医学平行病历更重视患者主观病痛与治疗体验的记录。如何通过医患共同决策来实现中医临床真实疗效的评价，是亟待解决的关键问题。课题组在前一个国家自然科学基金项目中，提出了医患共建平行病历的概念并以消化疾病为载体进行了方法探索。如何使该评价方法更客观、更具实操性，本研究拟运用结构方程模型(SEM)以及层次分析法(AHP)优化中医治疗胃癌前病变真实疗效的整体评价方法。研究通过临床专家的德尔菲和共识会议法，确定患者生活情绪评分、患者报告结局、医生评估症状积分、1-3年后胃镜及病理评分等指标，建立递阶层次结构，作为判断矩阵条目，结合专家共识及AHP层次分析法计算权重并一致性检验，进而通过SEM建立胃癌前病变医患平行病历疗效评价结构方程模型，实现整体评价结果的可视化和可溯源。本课题将为加强医患沟通、增强医患互信，提高中医临床真实疗效的整体评价水平提供新思路和新方法。

患者价值取向是循证医学三要素之一，叙事医学平行病历更重视患者主观病痛与治疗体验的记录。在消化内科临床中，如何通过医患共同决策来实现中医临床真实疗效的评价，是亟待解决的关键问题。针对于中医疗效评价，进行的医患共建平行病历的研究，需要在医患共同决策方面引入决策分析的新方法。本研究运用结构方程模型(SEM)以及层次分析法(AHP)优化中医治疗胃癌前病变真实疗效的整体评价方法。检索pubmed等重要数据库，整理了医患共建平行病历的理论和当前实践的临床试验的情况，以及AHP 和SEM 在中医真实疗效评价方面的应用方面的研究。组织临床专家进行德尔菲和共识会议法，确定患者生活质量评分、患者报告结局、医生评估症状积分、1-3年后胃镜及病理评分等指标，建立递阶层次结构，作为判断矩阵条目，结合专家共识及AHP层次分析法计算权重并一致性检验，建立了胃癌前病变医患平行病历疗效评价结构方程模型。完成了300余例病例收集，对部分病例进行了量表数据分析。完善了医患共建疗效评价数据库的信息，为进一步的效度信度检验提供数据支持，建立了健全医患共建循证评价的长期随访数据库。发表多篇医患共建相关中、英文文章，出版相关著作一本。诊疗过程中，增加患者的教育以及科普，达成了医患共建联盟，建立健康的秩序，从医生角度和患者角度进行全方位健康的回归。逐渐达到减少患者用药，降低住院和就诊次数，同时满足症状消失，实现健康管理。本研究加强了医患沟通、增强医患互信，并探索了符合临床实际的临床评价方法，为提高中医临床真实疗效的整体评价水平，促进医患共建式诊疗模式提供了新思路和新方法。

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