糖尿病自我管理分层支持系统设计

Design of the Hierarchical Support System for Self-management of Diabetes

目的:构建糖尿病自我管理分层支持系统,实现糖尿病的高效、智能管理。方法:借鉴糖尿病三级预防与分级诊疗的发展,以德尔菲法制定糖尿病分层分级支持的流程,并根据该流程设计系统整体结构与功能。结果:系统包括5个层次(门户层、应用层、服务层、数据中心、数据交换层)和2个应用支持体系(数据标准规范体系、信息安全体系),有信息收集、数据分析、自我管理处方、随访管理和图文咨询等功能。结论:系统设计科学,功能全面,可为不同人群提供精准、个体化的自我管理教育与支持的方案。

Objective: To construct a hierarchical support system for self-management of diabetes, and achieve efficient and intelligent management of diabetes. Methods: Based on the development of three-level prevention and grading diagnosis and treatment of diabetes, the Delphi method was used to formulate the process of hierarchical and classification support for diabetes mellitus, and the structure and function of the system were designed according to the process. Results: The system includes 5 layers(portal, application,service, data center and data exchange) and 2 application support systems(data standard specification system, information security system), with information collection, data analysis, self-management prescription, follow-up management, and graphic consultation.Conclusion: This system is scientific in design and comprehensive in function, which could provide accurate and individualized selfmanagement education and support programs for different diabetes.