A Study On The Regional Cooperative Emergency Cardiovascular Care Model Based On Mobile Internet Of Things

The risk factors of cardiovascular disease (CVD) are increasing persistently in Chinawith the morbidity and mortality of CVD remaining at a high level.The aggravating burden ofCVD becomes an important issue of public health.The prevention and treatment of CVDshould be reinforced immediately.The emergency cardiovascular care model,though maturein developed countries is still at exploring stage in China. This study is to build apeople-centred emergency cardiovascular care model with high efficiency, easyreproducibility and dissemination to facilitate the implementation of multiple clinical practicguidelines based on modern network information technology,which involved the fields ofinformation technology,management science and medicine.At theoretical level, the conception of time-space emergency cardiovascular care was firstexplored through comprehensive analysis and innovation on the cardiovascular CPGs,regional cooperative healthcare,information technology and related management theory.time-space emergency cardiovascular care was defined as to provide continuous emergencycardiovascular care for anyone, anywhere and anytime through regional cooperativehealthcare,which promotes evidence-based processes and modern network informationtechnology, resulting in improved quality outcomes for cardiac patients.Time-space emergency cardiovascular care mode could be developed under the supportof regional cooperative healthcare,which integrated the latest progress of emergencycardiovascular care process management and the most advanced communication technologyand information technology such as internet of things,cloud computing,telemedicine andm-Health.Specialists in rescue center can guide the remote-site first medical aid to elevate thesuccess rate of rescue as well as to promote the professional technology of rural/communityhospitals. Based on the real-time remote transmission system of life-monitoring,we set up theintegrative system of heart attack risk assessment, early screening, pre-hospital andin-hospital care,ICU treatment. Based on the network with rural/community hospitals,we established remote ICU and mobile ICU,so that informations of patients with CVD inrural/community hospital can be transmitted to central hospital. Specialists in central hospitalcould guide of remote-site first aid treatment and transport ST-elevation myocardial infarction(STEMI) patient more rapidly and safely.On the basis of above theory explored,two empirical researches were conducted.Firstly,retrospective charts review of8084patients with CVD or risk factors wereassessed by the the implementation of multiple clinical practic guidelines for CVD. Thesurvey showed that disparities in apparent manifestation and stratified risk levels,disparitiesin standard normal value and guidelines recommended treatment target,disparities inrecommendations between guidelines,the disparities in the manifested appearances andcomprehensive assessment,demonstrated the importance of implementation of guidelines,which will play an early screening role in emergency cardiovascular care model.Secondly,we studied the1st normalized Chest Pain Center(CPC)and the regionalizedCPC networks based mobile internet of things in China which was established in GuangzhouGeneral Hospital. Patients with acute chest pain before and after new mode established wereevaluated. Median D2B time decreased from121min in the control group to69min in thestudy group (P<0.001).The percentage of D2B times<90min increased from26.0%to82.5%between the two groups(P<0.001).After adjusting for patients and hospital characteristics,clinical pathway bypassing emergency department admission and pre-hospitalelectrocardiograph (PH-ECG) were independent predictors of D2B time within90min(OR1.973,95%CI:1.040~3.788, P=0.028and OR1.876,95%CI:1.030~3.465,P=0.021).In-hospital mortality of percutaneous coronary intervention(PCI),aortic dissection(AD) and other operations did not differ significantly between2groups(2.6%vs.2.4%,1.1%vs.22.7%,0vs.2.3%,respectivelyï¼›P>0.05). The mean hospitalization days and costs ofSTEMI,USTEMI,and AD were significantly reduced30.3%~42.3%,and8.0%~14.5%respectively in the study group (P<0.001). The study results showed that in-hospitalmortality,mean costs and days of hospitalization reduced by reducing time to diagnosis andtreatment, PH-ECG and clinical pathway bypassing emergency department admissionsignificantly reduces D2B time in STEMI patients.Finally,on the basis of the empirical study results,we conclude that new mode can helpto promote the professional skills of the physicians in rural/community hospitals in two ways: The circular training under the requirement of international certification of CPC helps toestablish the standard clinical pathways and the process of diagnosis and treatment.Theremote ICU helps to make decisions in daily practice with intensive care patients. Resourcesof general hospital were remotely used by rural/community hospital and promote the qualityrural/community hospital rescue more life. We should pay more attention to the importanceand normalized direction of CPC established in China,the most advanced IT and principles ofmanagement which used in this study may support the establishing of CPC.Emergency cardiovascular care model establishment should be organized in scrupulosityand designation,explored qualitative and quantitative methods in evaluation and analysis.Weshould definite the real demands of medical system in detail,promote optimized programstoward the existing emergency medical system,establish the standardization of emergencycardiovascular care model step by step to norm various kinds of social organization andindividual that may influence the emergency medical care.