绍兴第二医院医共体总院开展互联网+诊后疾病管理的实践与体会  

Practice and experience in carrying out Internet+post-diagnosis disease management in Medical Consumption Linkage Hospital of Shaoxing Second Hospital

作　　者：葛孟华[1] 章汝 章小华[1] 陈烨君[1] GE Menghua;ZHANG Ru;ZHANG Xiaohua;CHEN Yejun(Medical Consumption Linkage Hospital of Shaoxing Second Hospital,Shaoxing,Zhejiang Province,312000,PRC)

机构地区：[1]绍兴第二医院医共体总院,浙江省绍兴市312000

出　　处：《中国医院》2023年第12期118-120,共3页Chinese Hospitals

摘　　要：互联网+医疗健康服务是新形势下更好地满足人民群众对高质量医疗卫生服务需求的重要举措。笔者介绍了医院通过与第三方机构合作,建立诊后疾病管理平台,以医院为主导,组建由专科医师、专科护士、健康管理师和营养师或运动康复师等组成的个案管理团队,开展线上线下相结合的健康宣教、生活方式干预、用药指导、心理辅导、复诊提醒、管理评估等诊后疾病精细化管理,有效提升了患者的依从性,改善了疾病的预后,提高了患者的满意度和医疗资源的使用效率。Internet+medical and health services is an important measure to better satisfy the people's demand for high-quality medical and health services under the new situation.Through cooperation with third-party institutions,the author's unit has established a postclinic disease management platform,led by the hospital,established a case management team composed of specialists,specialized nurses,health managers,dietitians or sports rehabilitation specialists,and carried out fine management of post-diagnosis diseases such as online and offline health education,lifestyle intervention,medication guidance,psychological counseling,re-diagnosis reminder,management evaluation,etc,Effectively enhancing patient compliance,improving disease prognosis,improving patient satisfaction,and improving the efficiency of medical resource utilization.

关 键 词：互联网+ 诊后疾病管理 连续性医疗服务 

分 类 号：R197[医药卫生—卫生事业管理]