基于E-Coach管理模式的儿童多重慢病医疗过渡干预模型构建研究  

Construction of a Medical Transition Intervention Model for Multiple Chronic Diseases in Children Based on the E-Coach Management Model

作　　者：郭艺 韩烜烨[2] 刘昭君[2] 姜尧尧 付洋[4] 石磊 赵士宏[3] GUO Yi;HAN Xuanye;LIU Zhaojun;JIANG Yaoyao;FU Yang;SHI Lei;ZHAO Shihong(School of Nursing,Harbin Medical University,Harbin 150081,China;The Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China;The Sixth Affiliated Hospital of Harbin Medical University,Harbin 150027,China;School of Humanities,Harbin Medical University,Harbin 150081,China;School of Health Management,Guangzhou Medical University,Guangzhou 511436,China;Social Science Key Laboratory of Guangdong Higher Education Institutes for Health Management Policy and Precision Health Services,Southern Medical University,Guangzhou 510515,China;Social Science Key Laboratory of Guangdong Higher Education Institutes for Health Governance Based on Big Data Utilization,Guangzhou Medical University,Guangzhou 511436,China;Guangdong-Hong Kong-Macao Greater Bay Area Medical and Health Industry High Quality Development Rule of Law Guarantee Research Center,Guangzhou Medical University,Guangzhou 511436,China)

机构地区：[1]哈尔滨医科大学护理学院,黑龙江省哈尔滨市150081 [2]哈尔滨医科大学附属第二医院,黑龙江省哈尔滨市150086 [3]哈尔滨医科大学附属第六医院,黑龙江省哈尔滨市150027 [4]哈尔滨医科大学人文学院,黑龙江省哈尔滨市150081 [5]广州医科大学卫生管理学院,广东省广州市511436 [6]广东省高校健康管理政策与精准健康服务协同创新研究哲学社会科学重点实验室,广东省广州市510515 [7]广东省高校基于大数据利用的卫生健康治理哲学社会科学重点实验室,广东省广州市511436 [8]粤港澳大湾区医药健康产(行)业高质量发展法治保障研究中心,广东省广州市511436

出　　处：《中国全科医学》2025年第20期2530-2537,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(72104098);广东省基础与应用基础研究基金(2023A1515010902)。

摘　　要：背景随着医疗技术的进步,超过90%慢病患儿需从儿科医疗过渡至成人医疗,且患儿所患慢病数量越多,其发病和死亡风险越高。迄今为止,我国研究主要集中在成人多重慢病方面,目前尚无系统完善的多重慢病儿童医疗过渡干预措施。目的构建基于线上线下一体化健康教练慢病管理模式(简称E-Coach管理模式)的儿童多重慢病医疗过渡干预模型。方法于2024年4月,系统检索国内外儿童多重慢病医疗过渡期相关文献,由2位研究者进行独立筛选,对纳入文献进行方法学质量评估后,提取并汇总证据,经课题组讨论,初步形成基于E-Coach管理模式的儿童多重慢病医疗过渡干预模型。于2024年5—6月,经过两轮专家函询后,通过计算专家的积极系数、权威系数、协调系数,以及各级指标的变异系数确定最终的医疗过渡干预模型。结果共检索到1734篇文献,最终纳入11篇文献,汇总得到涉及干预目标、干预形式、干预对象、干预措施4个方面的36条证据。经课题组讨论初步构建的基于E-Coach管理模式的儿童多重慢病医疗过渡干预模型包含4项一级指标、13项二级指标和21项三级指标。2轮专家函询问卷回收率均为100.0%,专家权威系数分别为0.813、0.830,指标重要性的Kendall's W系数分别为0.270(χ^(2)=149.866,P<0.001)、0.321(χ^(2)=154.058,P<0.001),指标可行性的Kendall's W系数分别为0.266(χ^(2)=147.396,P<0.001)、0.362(χ^(2)=173.605,P<0.001)。最终形成的基于E-Coach管理模式的儿童多重慢病医疗过渡干预模型包括一级指标4项、二级指标10项、三级指标19项。结论基于E-Coach管理模式的儿童多重慢病医疗过渡干预模型具有较高的可靠性和可操作性,能为临床医护人员开展儿童多重慢病医疗过渡干预工作提供指导。Background With adva nces in medical technology,more than 90 percent of children with chronic diseases need to be transitioned from pediatric to adult care,and the greater number of chronic diseases a child has,the higher risk of morbidity and mortality.However,until now,research in China focused mainly on multiple chronic diseases in adults,and there are no systematic and comprehensive interventions for the transition of children with multiple chronic diseases.Objective To form healthcare transition intervention models for multiple chronic diseases in children based on the E-Coach management model.Methods In April 2024,a systematic search was conducted for domestic and international literature on the medical transition of children with multiple chronic diseases.Two researchers independently screened the literature,evaluated the methodological quality of the included literature,extracted and summarized the evidence,and initially formed an intervention model for the medical transition of children with multiple chronic diseases based on the E-Coach management model after discussion in the research group.From May to June 2024,two rounds of correspondence were conducted with experts using the expert correspondence method,and the medical transition intervention model was finalized by calculating the coefficient of expert positivity,the coefficient of expert authority,the coefficient of expert coordination,and the coefficient of variation for each level of entries.Results A total of 1734 documents were searched,and 11 documents were finally included,summarizing 36 pieces of evidence involving four aspects:intervention goals,intervention forms,intervention targets,and intervention measures.The E-Coach management model-based multiple chronic disease medical transition intervention model for children,which was initially constructed after discussion by the research group,contains 4 primary indicators,13 secondary indicators,and 21 tertiary indicators.The recovery rates of the two rounds of expert questionnaires were 100.0%

关 键 词：健康管理 E-Coach 多重慢病 医疗过渡期 德尔菲法 儿童 

分 类 号：R36[医药卫生—病理学]