Study On Community Hypertension Management Model Based On Resident Electronic Health Record

ObjectivesBased on the development of hypertension management model at H Town, combined with construction of electronic health records (EHR) of its residents, this paper aimed to illustrate and summarize the changes of informatization and the new community hypertension control model based on EHR, to compare the informatizatised hypertension management model and the tradition management model through qualitative and quantitative research methods, to provide experience for community hypertension management, and to provide evidences for policy making.Contents and MethodsThrough extensive literature review the research group described the domestic and overseas hypertension management model and the development of EHR in the public health field, analyzed the history of tradition community hypertension management model at Minhang District, existing problems and practical experiences. Research group analyzed work summaries and reports since2006, summarized the transition of EHR at Minhang District and the community hypertension management model based on EHR system and compared the informatizatised hypertension management model with the tradition management model. Moreover, after setting H Town as an example, research group investigated and described the practices and evaluation of traditional model quantitatively and qualitatively from the angels of management personals, service providers, and service objects. Combined with the construction of general practitioners working mode, research group proposed key techniques and policy recommendation on management mechanism and mechanism construction. ResultsThe community hypertension management model based on EHR had combined the strong points of comprehensive hypertension management mode, hierarchical management mode, self-management mode, and standardized management mode. Through data collection from EHR, surveillance and management of healthy population group, high-risk population group, and hypertension patients, the management mode had achieved early detection, early diagnosis, and early treatment, and provided effective, economic, convenient, comprehensive, and consecutive community hypertension management service to the whole population. Among these characteristics of hypertension management service mode, consecutiveness was of the most important.At H Town, less than20%of hypertension patients had hypertension management cards from2003-2006. After implementation of EHR in2007, more than80%patients had management cards, standardized hypertension management rate had passed90%. In qualitative analysis,93.95%residents had built their EHR at the community health centers at H Town.77.69%hypertension patients had their blood pressure measured by practitioners regularly and55.38%patients was followed up by fixed practitioners.66.40%patients knew that their EHR contained diagram of changes in blood pressure,51.71%patients had paid attention to their blood pressure diagram, and53.28%patients had checked their clinical visits and follow-ups in the EHR system.98.69%hypertension patients took their antihypertensive medicines regularly,96.85%patients had their doctors remind them of checking blood pressure or taking medicines through different notification means. All the residents in the investigation had signed contracts with the community health centers. The main reasons of contract signing included no charge on contract signing, consistent care from fixed practitioners, and free health consultation.586PACS,890MUSE, and682type-B ultrasonic inspections at level-one hospitals were read by specialists at grade-two hospitals through remote medical consulting system, and13residents had their gastroscopy and colonoscopy inspection through two-way referral pathway. Discussion and suggestionsWe preliminarily built community hypertension management mode based on EHR system. The new mode had multiple functions for hypertension control. From the management point of view, it increased filing rates of residents’health profiles, and enabled health data collection and surveillance. From service provision point of view, the new mode increased detection of hypertension, raised rate of standardized management, recruited a variety of population group, and increased clinic detection rate and follow-up rate. From service objects point of view, residents were satisfied with the new mode. Awareness and knowledge rate of hypertension and self-management had risen. Author suggested that information technology should furtEHR incorporate into the hypertension management mode, furtEHR develop and utilize the section for high-risk population of hypertension, strengthen quality control mechanism, improve performance evaluation mechanism, furtEHR promote family health profiles bonded with personal health profiles, carry forward the "three-in-one" working model, and improve two-way referral pathway.