| Background"The study in three-stage rehabilitation program of acute cerebrovascular disease" was carried out under the rehabilitation department of Huashan Hospital and combined with22hospitals all over the country ("Fifteen" national science and technology tackle key project). The research conclusion proved systematic and normative rehabilitation could effectively ameliorate movement function> cognitive function and promote the recovery of neurological function in stroke patients. It also could improve patients’living quality and greatly reduce morbidity. It is the first time to propose a "hierarchical and normative" three-stage rehabilitation project.In July2011,<The ministry of health builds perfect rehabilitation medical service system pilot work program> clearly put forward that the guiding ideology of rehabilitation medical service system construction is to optimize the layout and structure; to arrange rehabilitation and medical resources in area; to steadily build up hierarchical and grading rehabilitation medical service system; to provide patients with early, systematic、professional continuous rehabilitation medical services; Reducing disability; reducing the financial burden on families and society; increasing life quality and promote social harmony. In the same year in September, general office of the ministry of health carried out<Builds perfect rehabilitation medical service system pilot work>.It will choose14provinces throughout the country to carry out two-year pilot work of rehabilitation medical service system; to steadily build up hierarchical and grading rehabilitation medical service system; gradually build a rehabilitation of the health care system that is a reasonable distribution, structured, fully functional, and efficient. It meet the demands of people’s basic clinical rehabilitation services, reducing the incidents of disability, lightening the degrees of disability, improving the qualities of life, easing the burden on families and society, and promoting the social harmony. In March21,2012, the ministry of health department held a working conference that specialized the research and arrangement of the management and development in rehabilitation. It further defined the overall direction and vision of the development in the work of rehabilitation in the "twelfth five-year" period. Deputy health minister Ma Xiaowei said in the meeting that the rehabilitation is the short of medical service system in our country, and the construction and development of rehabilitation should be contained in the big plate of health-care reform. We need to focus on building a rehabilitation hospital, and the key breakthrough is the classification of medical treatment and the implementation of two-way referral. According to the<twelfth five-year" period of rehabilitation medical work instruction opinion> which had issued by the health ministry, China will preliminary establish a layered and phases of rehabilitation medical service system, and gradually achieve the patient to grade and transfer between the general hospital, rehabilitation hospitals, and primary care health institutions.Fourteen constructions in the "rehabilitation service system" had obtain the huge achievement, but also found some problems:1) The organization management system in the regional rehabilitation service system is not sound. The autonomous and unclear function division among various medical institutions against the construction of the overall rehabilitation service system and the two-way referral. It also causes the plateau patients to stuck in the general hospital, but less patient in the community hospital. 2) The quality in the grass-roots hospital is generally low because the rehabilitation is lack of standardization. That led the poor ability to solve the problems and the loss of the trust by the patients at the grass-roots level.3) Currently, the development of the rehabilitation is imbalanced, the level of the treatment is irregularities, and the treatment is also wide variations. This was not only seriously violated the original intention to implement the standardized treatment by the health ministry, but also caused a serious influence to the life and health of patients. General practitioners mainly undertook the actual rehabilitation treatment in the community health service institutions. Because of the general lack of rehabilitation knowledge and training by formal rehabilitation institutions, the diagnosis and treatment of rehabilitation is irregularities.Clinical decision support system (CDSS or CDS) that is also called electronic medical expert system. It is an interactive decision support system (DSS) that conclude certainty diagnosis, standardized treatment and patient data mining functions to assist the physicians and the other health professionals. It guides the doctors to make decision by means of managing health knowledge, which improves the quality of medical health standardization for providing guidance. It is a kind of medical major topic of artificial intelligence.Decision support system based on computer system. It can help decision makers use decision-making information and decision model and solve the unstructured and semi-structured decision problem by the man-machine interactive way. It assists decision makers to judgment and analysis, not to replace the decision makers. Decision support system is a kind of strategic information system that provides interactive application information to support managers in strategic decision-making process. Due to the processing of the technical and political information, the operation information is tends to semi-structured and unstructured. Semi-structured decisions are the part program to determine the single details that remain uncertain. Because the decision support system is mainly used to help manager to solve the semi-structured and unstructured problem, and the management consulting system is to assist in solving problems that more structural. Decision support system whose core is artificial intelligence, it develops the human intelligence into computerization that enable the computer with thinking, learning and solving problems.According to the article fifth of the first chapter in<the standards of electronic medical record system (trial version)> which launched by the health ministry in2010, the function of the electronic medical record system was divided into three levels that is required, recommended and optional. With the continuous development of information technology to involve deeply in the field of health care, we gradually completed the construction of the necessary functions. As the decision support system to be a major topic of artificial intelligence, more and more health care industries paid an attention to it. According to the speed of development in the electronic medical records, the health bureau launched<the standards and the methods of grading evaluation in the electronic medical records>, in which began to mention senior medical decision support and the regional medical information sharing functions.ObjectiveThis project based on rehabilitation diagnosis and treatment decision support system. On the horizontal business, it applied intelligently electronic information technology to improve the normatively of rehabilitation diagnosis and treatment and the ability to solve problems in primary hospital. On the vertical business, it achieved the decision support of graded hospital and two-way referral by setting the rules of medical institutions’(in the regional rehabilitation service system) functional position and service area. And through the "data center" function, the "information island"between the medical institution was Broken, the integrity and continuity of rehabilitation diagnosis and treatment was achieved and fundamentally eased the people’s problem which is "Difficulty and cost of treatment". In the meantime, used the data exploration technology to constantly integrate and analyze all clinical data in the heterogeneous database, set a lot of rules which are after clinical validation, eliminate the original expert consensus and master the clinical diagnosis and treatment work to make the rehabilitation diagnosis and treatment decision support system full of vitality.Methods 1. This article used the literature analysis method to collect, identify and put in ordering literature at home and abroad whose mainly term is "decision support system, regional three-level rehabilitation service system" and so on. And analyzed the research statuses at home and abroad in order to provide theoretical basis and thinking source for research project.2. The outline contains all sorts of questions or topics, such as "regional three-level rehabilitation service system, decision support system"(also known as "topic guide"). We conduct semi-structured interviews to collect the feasibilities, problems, methods, risks of "regional three-level rehabilitation service system" by face-to-face or telephone interviews.3. The "focus groups" of the project contained various people such as chief physician, physicians, and therapists from our hospital, physicians, and therapists from primary hospital, the health administrative managers, recorders, programming personnel, and the patients. Each person tentative interpreted the outline of the subject, and then the others should veto and support. We should form the meeting record after the meeting.4. We adopted the methods of "subject analysis" that chose the matrix method for each topic with each line represents a new theme, and each column represents a "case"(such as an interview record). And then we intercepted the relevant paragraph in the text to fill each box.5. In the design phase of the rehabilitation medical decision support software, we take the method of facing object software engineering. According to the user’s business activities and requirements analysis, we should find out all kinds of the categories, scopes and associated projects of the data to adopt the method of data warehouse design for system.6. Data exploration function can be realized the clinical rehabilitation decision support system to operate effectively. We adopt empirical method to implement the processes of the data selection, data mining, data statistical analysis, and data interpretation. So we can conduct the clinical diagnosis and treatment rules and enhance the level of clinical diagnosis and treatment. Results1. By means of literature analysis, we know the progresses of the rehabilitation service system at home and abroad. As the rehabilitation service system was being implemented, the domestic difficulties and breakthrough points emerged, which was promoting the diagnosis and treatment of primary hospital, and perfect the two-way referral.2. Through semi-structured interview, focus group method, analyzed the key technology of decision support system for diagnosis and treatment and recovery of software requirement analysis, design and overall model of the system, overall framework, function architecture platform architecture, business application system. The overall model including the lateral and longitudinal model; Overall framework including data management system, business application system, database, the three modules; This software system adopts the CS+BS architecture, business module USES the CS mode, running on Android tablet computer system; Business use of system function structure design on user login, doctors management module, the therapist management module, management module, director of the four big modules.3. Within the data management system, we use data exploration technology, carried out "the RF heat coagulation target ablation for patients with lumbar disc protrusion" empirical research on selection decisions. Among all patients, the VAS scores of the type Ⅰ,Ⅱ,Ⅲ all decreased sharply compare to the VAS scores at pre-operate (P=0.00<0.01), and significantly improved the angle of the Lesage Test of type Ⅱ,Ⅲ at3days compare to pre-operate (P=0.00<0.01). Although the VAS scores of the type Ⅳ at3days showed some improvement compare to pre-operate (P=0.00<0.01), no improvement of the clinical symptoms was achieved (P=0.11>0.05).The VAS scores and the modified Mac Nab criteria at one month showed no improvement compare to3days (P=0.414>0.05). The effective rate was70%and the remarkable effective rate were only50%at one month.Conclusions: By developing the decision support system for rehabilitation and treatment of construction of regional tertiary rehabilitation service system, on the horizontal business diagnosis, rehabilitation evaluation, rehabilitation treatment on the rehabilitation and treatment to provide intelligent decision support all the way, on the department management, set the director of "module", the management department to provide auxiliary decision analysis. On vertical business, within the rehabilitation service system on medical institutions function of decision support, to avoid the conflict of interest between the regional rehabilitation institutions; Automatically at the same time, in the "data center" by putting the patient medical records of the upload issued and implemented the rehabilitation treatment of two-way referral continuity and integrity.Exploration technology in data management system, using the data carries on the empirical research, we conclude that in patients with lumbar disc prolapsed, after the hospital, should be normal lumbar CT examination, and make Suggestions according to the morphological classification of the society of orthopedic surgery, including advice II type and III type lumbar intervertebral disc protrusion patients considering RF thermosetting target ablation, but for patients to think carefully about IV type lumbar intervertebral disc protrusion, turn suggested that patients with orthopedic surgical treatment."Data center" of the data exploration continuously, promote knowledge discovery, constantly updated supplementary pattern library, make rehabilitation treatment decision-making system has vitality, improve diagnosis and treatment decision-making system recovery capability. |
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