Construction And Implementation Of Digital Diabetes Management Care Pathway

The diabetes patients of china have a large base,rapid growth,and heavy burdens.Effective diabetes management is of positive significance for improving the treatment rate and control rate of diabetes.At this stage,diabetes management uses mobile medicine as an important means,chronic disease management model as theoretical guidance,and diabetes prevention and management guidelines as knowledge guidance to manage patients.However,this management method lacks a specific definition of the diabetes management process,the management process is not highly executable,and the actual management efficiency is low.In the early stage of chronic disease management research,this research group proposed the construction method of chronic disease management pathway,and applied them in the actual management of hypertension and COPD to prove that the chronic disease management pathway is an effective chronic disease management method.According to the high incidence of multiple cardiovascular risk factors and multiple acute complications of diabetes,the main goal of this paper is to design and construct a closed-loop management path for diabetes that can achieve doctor-patient interaction and comprehensive evaluation management.And adopts ontology technology to carry out digital and executable modeling expression,and implements system based on mobile medical technology to help doctors manage patients in a standardized manner,realize comprehensive management,and improve management efficiency.The specific research content of this paper includes:(1)Design and construct the diabetes management care pathway.First,summarize the main task set of diabetes management through diabetes prevention and management guidelines,then discuss with experts to define the timing and process of doctor-patient intervention,refer to the time sequence diagram of chronic disease management path,construct a closed-loop management path for diabetes,and finally through interviews with experts and multiple guidelines Interpretation,instantiate the content of each module of the diabetes management path,including the comprehensive evaluation-management plan,and the specific content of the follow-up intervention.(2)Use ontology and rule technology to build an executable digital diabetes management path.On the basis of the foregoing research results,referring to the existing diabetes ontology construction process and the seven-step method of Stanford ontology construction,a three-level structure of diabetes management path ontology model framework is designed,and the ontology is initialized based on this framework to complete the diabetes management path field The construction of ontology,and finally on the basis of ontology knowledge base,carry out the design and construction of executable SWRL rules.(3)Design and development of diabetes closed-loop management system.Based on the expression results of diabetes management path modeling,design and implement the diabetes closed-loop management service engine,and realize the development and integration of the diabetes closed-loop management system through application interaction with mobile terminals(doctor end,patient end),and carry out the actual diabetes management application.(4)The digital diabetes management path is evaluated in practice.The system has been promoted in Zhejiang,Ningxia and other medical institutions,and has been in the group to manage 2302 people with diabetes and continue to increase.We made a comprehensive assessment of the methods and systems proposed in this study,and the results showed that the average blood sugar level of diabetic patients managed by the system decreased significantly,and the average blood pressure level of some diabetic patients with combined hypertension improved significantly.At the same time,the digital diabetes management path proposed in this study also has a positive effect on improving the efficiency of doctors.The digital diabetes management path proposed in this paper provides guidance for the timing and content of the interactive intervention between doctors and patients,standardizes the medical service behavior of doctors,and realizes the comprehensive management of diabetic patients through the "comprehensive assessment-grade management-follow-up" circular closed-loop scheme,and applies it in the actual diabetes management,which is of great significance in improving the effect of comprehensive diabetes control and improving the efficiency of health care workers.