“互联网+专家团队”驱动的高血压分级诊疗模式探索与实践

Exploration and Practice of Graded Hypertension Hierarchical Medical Model Driven by“Internet+Expert Team”

结合国内外基层高血压诊治与管理的经验,本团队构建了“互联网+专家团队”的社区高血压管理新模式,并建立云数据平台。该平台可实现在不同类别医疗机构间共享患者信息,实现有序的双向转诊、急慢分治和上下联动机制;可开展多学科交叉授课,提升基层全科医师的高血压慢性疾病规范化诊疗水平;可实现高血压患者信息连续记录,为后续合理用药提供依据、提高基层医院治疗满意度和患者的血压达标率。建议信息技术成熟的基层医疗机构可尝试“互联网+专家团队”的社区高血压管理模式。

Combining the experience in the diagnosis,treatment and management of primary hypertension at home and abroad,the team has constructed a new model of community hypertension management of“Internet+expert team”and established a cloud data platform.The platform can realize the sharing of patient information among different types of medical institutions,and realize an orderly two-way referral,emergency and slow treatment,and upper and lower linkage mechanisms;it can carry out multidisciplinary cross-teaching,and improve the standardized diagnosis and treatment of hypertension and chronic diseases among general practitioners at the basic level;can achieve continuous recording of information on patients with hypertension,provide a basis for subsequent rational use of drugs,and improve the satisfaction of treatment in primary hospitals and the rate of blood pressure compliance of patients.It is suggested that basic-level medical institutions with mature information technology should try the community hypertension management model of“Internet+expert team”.