临床决策支持在乳腺癌患者随访管理中的应用与成效评价  

Application and effectiveness evaluation of clinical decision support in breast cancer follow-up management

作　　者：杜萍[1] 周峥[1] 陆瑶[1] 白春花[1] 薛永凤[1] 朱春宁[1] DU Ping;ZHOU Zheng;LU Yao;BAI Chunhua;XUE Yongfeng;ZHU Chunning(General Surgery Department,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,210002,China)

机构地区：[1]南京大学医学院附属鼓楼医院甲状腺乳腺外科,210002

出　　处：《中国护理管理》2021年第1期110-115,共6页Chinese Nursing Management

基　　金：南京大学医学院附属鼓楼医院2020年院级科研基金(ZSB734)。

摘　　要：目的 :构建基于临床决策支持的乳腺癌患者全流程信息化管理系统,辅助医护人员进行随访决策,挖掘数据价值,探讨其对乳腺癌患者进行随访管理的有效性。方法 :由多学科专家合作设计知识库、推理引擎及用户沟通机制等系统内容,完善系统后投入临床使用。遴选2018年12月至2019年12月入住本院乳腺外科的乳腺癌患者共88例,随机分为实验组和对照组,对比两组患者干预前、干预后3个月和干预后6个月骨髓抑制情况、再入院率、自我效能感以及实验组患者对系统的满意度评价。结果 :两组患者干预前白细胞、血红蛋白、血小板无差异(P>0.05),3个月和6个月时实验组白细胞、血红蛋白、血小板均高于对照组(P<0.05);实验组3个月、6个月的再入院率均低于对照组(P<0.05);两组患者干预前自我效能无差异(P>0.05),3个月和6个月对照组自我效能均低于实验组(P<0.05);患者对系统的满意度高。结论 :根据乳腺癌患者的随访特点进行临床决策支持系统的开发,符合医护人员对病患进行随访的需求,提高了医护人员对系统的使用频率、保障了患者安全、提升了护理服务效率,从长远角度看降低了患者花费和医院运营成本。Objective: To develop a full-process information management system for breast cancer patients based on clinical decision support, assist medical staff in making follow-up decisions and excavate the value of data, and explore the effectiveness of follow-up management for breast cancer patients. Methods: A system combined with knowledge base, reasoning engine and user communication mechanism was designed by multidisciplinary experts and put into clinical use. A total of 88 breast cancer patients admitted to the breast surgery department from December 2018 to December 2019 were selected and randomly divided into experimental group and control group. The bone marrow suppression, readmission rate, self-efficacy and satisfaction evaluation of patients in two groups were compared before intervention, 3 months and 6 months after intervention. Results: There was no difference in leukocyte, hemoglobin and platelet between the two groups before intervention(P>0.05). White blood cells, hemoglobin and platelets in the experimental group were higher than those of the control group at 3 and 6 months after intervention(P<0.05). The readmission rate at 3 and 6 months after intervention in the experimental group was lower than the control group(P<0.05). There was no difference in self-efficacy between the two groups before intervention(P>0.05). The self-efficacy of the control group was lower than that of the experimental group at 3 and 6 months after intervention(P<0.05). The patients were highly satisfied with the system. Conclusion: The development of clinical decision support system based on the follow-up characteristics of breast cancer patients meets the needs of medical staff for follow-up of patients, increases the frequency of use of the system, guarantees patient safety, and improves the efficiency of nursing service. In the long run, it reduces patient cost and reduces hospital operating cost.

关 键 词：临床决策支持 乳腺癌 随访管理 

分 类 号：R47[医药卫生—护理学]