The incidence and disability rate of chronic kidney disease (CKD) are rising, which has become one of the major public health problems in China. Once CKD patients progress to end-stage renal disease, they must rely on renal replacement therapy for a long time to maintain their lives, which is expensive. At present, CKD patients have only a few days to get face-to-face guidance from nephrologists, and most of the time they rely on self-management and nursing. With the further development of information technology, what is the application status of "internet plus" in integrated management of chronic kidney disease? Next, I will show you the insights of Professor Fu Ping from West China Hospital.
China CKD has a heavy burden.
Professor Fu Ping pointed out that chronic kidney disease, as a major public health problem in China, is mainly reflected in the following four aspects:
(1) High prevalence rate: Data show that there were 697.5 million patients with chronic kidney disease (CKD) in the world in 20 17 years. Among them, nearly one third of CKD patients are in China and Indian, and the number of patients is1320,000 and1150,000 respectively. The average prevalence rate of adult CKD in China is 10.8%, and the prevalence rate in southwest China (18.3%) is the highest.
(2) It is closely related to poor prognosis: once CKD progresses to ESRD, the risk of death is 20 times higher than that of normal renal function. According to statistics, in only 20 17 years, CKD caused10.2 million deaths worldwide (the first 12 cause of death in the world).
(3) The incidence of CKD and ESRD continues to rise: China has a heavy burden of aging, diabetes and hypertension. Diabetes has become the first cause of CKD in China, and 32.7% of urban residents suffer from CKD with diabetes as the primary disease. According to statistics, in 20 19 years, the number of hemodialysis patients in China has reached 7 10000.
(4) High medical and health expenditure: According to the annual report of China Kidney Disease Data Network 20 15, the total medical expenditure of dialysis patients is 429 million yuan (medical insurance pays 76.6%). Hemodialysis and peritoneal dialysis patients only account for 0. 16% and 0.02% of all medical insurance patients, but account for 2. 1% and 0.3% of the total medical insurance expenditure. Patients with normal or slightly decreased renal function account for the majority of all CKD patients. If these patients are managed effectively for a long time and the time of entering dialysis is delayed, medical and health resources will be greatly saved. For the management of CKD, a huge patient group, if Internet technology and platform can be effectively applied, the management effect of chronic diseases will be greatly improved and the health burden will be effectively reduced.
There are some shortcomings in the management mode of chronic kidney disease in China.
Professor Fu Ping believes that CKD needs long-term intervention from early screening, prevention, control of complications, slowing down the deterioration of renal function and improving the quality of life of patients because of its long-term, gradual, multi-risk factors and poor prognosis. In the early years, there was not enough support of CKD (especially for end-stage dialysis patients) cost data and health economics data, which led to the late start of CKD chronic disease management in China, and the work content was complicated and time-consuming. There are still many aspects that need to be further improved:
(1)CKD patients have long waiting time but short visiting time, which leads to a general lack of knowledge about teaching, and many patients' lifestyles and medication are inappropriate.
(2) The overall management mode planning is still deficient, and the allocation and application of medical resources are unreasonable;
(3) Most CKD management models focus on medical intervention rather than prevention;
(4) 4) The prescription of CKD patients is complicated and the effect is poor;
(5) Patients with 5)CKD receive emergency treatment instead of long-term care;
(6) The hemodialysis center lacks effective quality control system and public service evaluation system;
Application status of internet plus in the management of chronic kidney disease
The mode of intelligent consultation, payment, diagnosis and follow-up based on Internet technology platform is very common. Professor Fu Ping briefly described the application status of internet plus in the following aspects.
0 1
Intelligent diagnosis
The clinical assistant decision-making system based on artificial intelligence is gradually applied in clinic, showing high diagnosis and prediction efficiency. Compared with manual observation, computer algorithm has better repeatability and accuracy, and can better identify subtle lesions. The automatic evaluation process can effectively save manpower, and it is feasible because it is based on a large sample study of pathological diagnosis. In predicting renal function decline, convolutional neural network algorithm is superior to the pathological evaluation results of traditional pathological scoring system in predicting renal survival rate, creatinine level and urinary protein in CKD patients. At the same time, the algorithm can identify the individual characteristics of CKD patients more accurately. Using the comprehensive electronic medical database of CKD patients and the existing technology, we can also identify the risk factors related to CKD and intervene in advance, so as to intervene the occurrence and progress of CKD early from the primary and secondary prevention levels. At present, artificial neural network, decision tree and Bayesian belief network are the main prediction methods in the field of kidney diseases. Most studies using these methods can predict renal failure events with high sensitivity and specificity.
02
Standardized follow-up
Judging from the construction of clinical follow-up database, the current CKD intelligent follow-up model still has the following shortcomings: (1) There are many kinds of apps, and there is a competitive relationship among them. Doctors only have the right to view the follow-up data of their own patients, but the follow-up data of CKD patients cannot be managed in a unified way; (2) Health records and follow-up data are established and entered by patients themselves, and the reliability of data sources and the accuracy of data entry need to be further verified. At the same time, for the sake of data security, the follow-up data of such CKD patients can not be connected with the hospital information system at present, which directly affects the data integrity and feasibility of clinical research of CKD patients.
For CKD patients, scientific follow-up design and long-term compliance of patients are very important. In recent years, there are many kinds of follow-up management software specially developed for CKD in China, but their functions are basically similar to those of users. The main functions of the patient client include establishing personal health information files for patients, inputting vital signs, laboratory results, symptoms and medication information, and the subsequent software will give timely feedback and medical advice (such as early warning of abnormal values such as blood pressure, creatinine and hemoglobin) according to the changing information of health data. In the process of data entry, some apps adopt the technology of picture text recognition, and patients can directly take pictures and upload them to text records, which greatly reduces the error probability of secondary entry.
03
Dialysis center management
Dialysis treatment of ESRD patients is expensive, so we should choose a treatment mode with low medical expenses, excellent treatment effect and help patients return to society. Peritoneal dialysis has the above advantages, but it is not the first choice in clinic because of the relative shortage of medical resources in China. The "internet plus" three-medical linkage management model of peritoneal dialysis center is a reform model recommended by China in recent years. Based on the collaboration of medical care, medical insurance and medicine, it standardizes the management of peritoneal dialysis, highly applies internet plus technology in operation management, scientifically integrates instruments, servers, doctors, patients, telemedicine and other links, establishes an alliance of networked management institutions, and integrates patient tracking, intervention, education, follow-up and orientation.
Experience of Chronic Kidney Disease Management Center in West China Hospital
The development of CKD management center in Nephrology Department of Huaxi Hospital has gone through five stages: center construction, patient education system construction, quality improvement, software management system startup, clinical and scientific research nursing training.
At present, the center has followed up about 1600 patients, forming a large-scale CKD follow-up center integrating doctors, nurses and nutritionists. The MDT team in the center guides the diet, living habits, medication and vascular access preparation of CKD patients throughout the process. Regular follow-up includes demographic variables, vital signs, various examination indexes and prognosis, which can track and improve the quality of life of CKD patients in many ways. Under the intervention of this model management, the amount of vascular access surgery for CKD patients in the Department of Nephrology of West China Hospital increased significantly (the amount of internal fistula surgery, central venous catheterization and vascular access intervention surgery all increased), and the number of outpatients in CKD specialty increased significantly, while the average length of stay and the proportion of medical expenses for CKD patients decreased significantly in the same period.
CKD Management Center of Nephrology Department was established in August, 20 1 1 year, and established the follow-up team, follow-up process and follow-up files. Since March 20 12, a series of regular lectures on CKD patient education have been made, and the first patient meeting of CKD management center was held in February 20 12. From June, 2065438 to June, 2003, the follow-up software system of CKD management center was put into use, and at the same time, the training class for specialized nurses in nephrology was held, which improved the teaching level of inpatient department and the compliance of outpatient follow-up, and gradually reserved the follow-up strength for sick teachers.
Although CKD Management Center of Nephrology Department of Huaxi Hospital has been established for 65,438+00 years, it is short of teachers and human resources. Although the CKD follow-up software system has been used since June 20 13, the software system is updated slowly, the database is relatively independent, and its running ability is far from meeting the clinical needs. Moreover, 85% of outpatients are foreign patients, so it is difficult to maintain patients' compliance. In August 2020, with the help of Xuetong, a new follow-up management software system was launched. With the support of the construction of smart hospitals in the whole hospital, the number of patients in follow-up management will increase greatly, the follow-up process will be convenient, and the construction of scientific research database will be accelerated.
Application prospect of "internet plus" in CKD comprehensive management
Information system integration is the foundation: medical electronic medical record system, doctor-patient information interactive information system (including chronic disease-related follow-up and remote monitoring), medical expert decision-making early warning system, public health, medicine and even insurance system will be continuously integrated, paving the way for building the most comprehensive CKD medical database.
The application of "internet plus" in CKD management will go deep into the community, which will help to integrate and * * * enjoy the health records of community residents, and lay an Internet framework for CKD's national education management and primary prevention of disease reduction. Based on the comprehensive medical database, using artificial intelligence to analyze the future gap of medical resources, providing guidance and suggestions for the formulation and improvement of medical policies, will effectively integrate CKD medical resources. Upgrading the current "internet plus" mode to "Internet of Things+"mode can accurately identify, locate, monitor and manage smart devices in real time, which will greatly facilitate the future CKD telemedicine and intelligent self-management of patients, and effectively improve the quality of any treatment (such as dialysis) involving instrument testing.
The application of "internet plus" and "Internet of Things+"technology in chronic disease management should be fully integrated, and a unified CKD patient management service platform should be established. There is even the Caesar model of chronic disease management in CKD, China: a medical group integrating medical services and medical insurance, which has the dual advantages of health services and cost control, covering the whole process from disease prevention, disease diagnosis and treatment to post-illness rehabilitation, with a view to further bringing subversive changes to chronic disease management, doctor group formation and payment model in China, improving the level of medical services and improving the prognosis and survival of patients while controlling costs. At the same time, hemodialysis is expected to achieve group and network management in the future, with a third-class first-class hospital as the main axis, radiating multiple community hemodialysis centers, establishing a transparent and open quality control system, and further realizing the accurate service management of CKD patients at all stages.
Summary:
Nephrologist is the leader of comprehensive management of chronic kidney disease, patient education is the key link of CKD follow-up, full-time patient teachers are the core members of follow-up management, nutritionists are an important part of the follow-up team, and mental health doctors and rehabilitation therapists who join the follow-up system will serve as important support and supplement. Internet technology and platform is the hub to connect the above links, and it is the necessary condition to provide convenient follow-up, establish high-quality medical database and promote scientific research output. With the overall speed-up of the national three-level diagnosis and treatment system and the strong promotion of the sinking of high-quality medical resources, we will surely usher in a new spring of CKD chronic disease management by making full use of the powerful help of internet plus.