Research On Self-Management Support Program For Patients With CKD Based On Cloud Medical Health Information Platform

BackgroundsChronic Kidney Disease is an irreversible disease characterized with high prevalence and mortality rate.Its management is mainly self-management at home.However,the survey shows that patients conduct poor self-management behavior at home and lack of continuous self-management support^[1,2].Domestic existing research only focused on the medical management such as disease-related knowledge,medication,diet,etc.And these studies were conducted in the form of outpatient lectures or telephone follow-ups.Moreover,China lacks a chronic disease management platform that can effectively improve the self-management ability of patients with CKD,and currently there are some problems in chronic disease management,such as high hidden costs for patients and easy forgetfulness of oral knowledge.In recent years,foreign studies have pointed out that there are gaps between patients’self-management support needs and the support provided^[3].In addition to existing information and instructions,the needs of the patient’s perspective should be explored^[4,5].With the exploitation and development of artificial intelligence based on big data,its advantages of convenience,real-time,accessibility and interactivity provide new ideas and methods for self-management support of discharged patients.In the early stage,according to the characteristics of the whole process of chronic disease management,the research group developed a chronic disease cloud medical health information platform based on tertiary hospitals.Therefore,how to construct CKD mobile chronic disease self-management support program based on this platform and carry out clinical empirical research can provide scientific basis for further improving the self-management ability of patients.ObjectivesIn this study,we aim to construct a self-management support program for CKD patients based on the chronic disease management platform（including the patient side and hospital side）,which is developed based on the characteristics of the whole process of chronic disease management.Patients were graded according to CKD stage and risk.The core indicators of patients are monitored and managed through the cloud medical health information platform.The disease management project is dynamically managed through timely formulation and individualization and specialization of dynamic push.The relevant results could be applied in tertiary hospitals—community health centers—families to improve the nursing care of CKD in primary hospitals and patients.Finally,to reduce the rate of re-morbidity and re-hospitalization.MethodsThrough literature review and semi-structured in-depth interviews with CKD patients,we formulated a self-management support project for CKD patients based on cloud medical health information platform,related experts are selected to conduct expert meetings,revise the structure and content of the project,and we finally formed a scientific and operable project.And whether the application of the project based on cloud medical health information platform constructed in the early stage has an impact on indicators such as self-management behavior,self-efficacy,quality of life,re-hospitalization rate and serum albumin of patients with CKD,so as to verify the effectiveness of the project.1.Construction of self-management support project for patients with CKD（1）Through qualitative research,we conducted semi-structured interviews with14 CKD patients to explore their needs for self-management support and the ways and sources of obtaining self-management support.（2）Based on the literature review and qualitative interview,the initial self-management support project for CKD patients based on cloud medical health information platform was constructed,and the project was revised by expert meeting to form the final project.2.Preliminary experiment and effect evaluation of self-management support project for CKD patientsQuasi-experimental study was adopted in this study,180 CKD patients who met the inclusion and exclusion criteria to be discharged in two branches of a tertiary hospital were divided into the experimental group and the control group equally.The control group accepted the routine hospitalization care and discharge guidance,and the experimental group accepted the platform-based self-management support besides the routine care,then the effects of self-management behavior,self-efficacy,quality of life,rehospitalization rate and albumin were compared between the two groups three months later.Results1.Construction of self-management support project for patients with CKD（1）Qualitative interviews showed that self-management support needs of CKD patients include disease-related knowledge,life management,disease management,emotional management,maintenance of family and social function management,and most patients want to obtain self-management support from nurses in the form of internet and telephone follow-up.（2）Combined with the results of literature review and qualitative interview,the initial self-management support program for patients with CKD was constructed based on cloud medical health information platform.After discussion and revision by expert,the final program was formed,including the health education,instruction,follow-up,discussion group and the reminder of the platform.2.Effectiveness evaluation of the self-management support programThree months later,a total of 156 patients,78 in the experimental group and 78 in the control group,completed the data collection,The results showed that the self-management behavior,self-efficacy and quality of life of the experimental group were significantly higher than the control group（p<0.05）,the albumin was significantly higher than the control group（p<0.05）,and the rehospitalization rate was significantly lower than that of the control group（p<0.05）;However,There was no significant difference in hemoglobin,creatinine,GFR and BP（p>0.05）.ConclusionSelf-management support program based on cloud medical health information platform can effectively improve self-management behavior,self-efficacy and quality of life of patients with CKD,increase the albumin and reduce rehospitalization rate.However,it cannot improve the hemoglobin,serum creatinine,GFR and BP.