“互联网+护理服务”老年慢性病智能随访系统的构建及应用

Construction and application of the"Internet+Nursing Service"intelligent follow-up system for older adults with chronic diseases

介绍了“互联网+护理服务”老年慢性病智能随访系统的总体设计思路和具体实施方法,包括基于疾病生理变化客观指标及患者自我报告主观感受等多维数据实现随访需求的精准评估和诊断、循证知识库支撑的随访智能决策、以护士为主导的线上与线下相结合的随访服务。该智能系统的应用构建了满足老年慢性病患者多样化、多层次随访需求的随访模式,调动了护士的积极性,为未来全面开展“互联网+护理服务”提供了有益借鉴和启示。

This paper introduced the construction and application of"Internet+Nursing Service"intelligent followup system for older adults with chronic diseases.The system included accurate follow-up needs assessment based on patient-reported outcomes,intelligent decision making engine supported by evidence-based knowledge base,and flexible and comprehensive online and offline follow-up services.The application of the intelligent system has brought benefits to patients,constructed a new follow-up practice model to meet the diversified and multi-level follow-up needs of older adults with chronic diseases,increased the enthusiasm of nursing staff,and provided a useful reference and enlightenment for the comprehensive development of"Internet+Nursing Service"in the future.