The Preliminary Exploration Of Chronic-disease Management And Regional Information Platform For Citizens Over Age Of55in Urban Communities

Objectives Take the population over age of55in urban communities of Qionghuaguan and Hehuachi as subjectives, by establishing Electronic health records, health education and regional information platform, we aim to explore the the management of chronic-disease and try to form the sharing-model of medical information, Finally in order to lay the foundation of the realise of "ailment cured in community,serious illness cured in hospital".Methods We first design the health questionnaire to survey and analyze common chronic diseases and epidemiological datas.Based on the investigation Electronic health records are established, we also make Medical Health Card and develop regional information platform to realise the sharing-model of medical information between hospital and community, we carry out health education in various forms and contents and evaluate the awareness rate of chronic disease and the improvement of bad habits before and after the education.Results1.The health survey indicate that according to the morbidity the most common chronic diseases are hypertension(45.94%), diabetes mellitus(15.40%), coronary disease(10.56%), cerebrovascular disease(3.84%), prostatic hyperplasia is27.68%.2.The coverage rate of Electronic health records is95%, made of modules of health information,medical information,the follow up and management, health education.3.Regional information platform has been set up, made of discharge records, doctor communication, health education and two-way refferal.4.Medical education are shared between hospital and community by reading the Medical Health Card.The evaluation before and after the health education shows that health education may rectify the unhealthy life style.5. The result of management of chronic-disease patients lay down foundation for two-way referral.Conclusions1.As the carrier of the chronic-disease management, Electronic health records promote the instant and dynamic management of chronic disease.2. Multiform health education rectifies the unhealthy life style of and will improve the self-management of the residants.3. The establishment of regional information platform helps realise the sharing-model of medical information between hospital and community and lays foundation for two-way referral.