| At present,it is estimated that there are 290 million patients with cardiovascular disease(CVD)in the country,including 270 million hypertension,13 million stroke,and 11 million Coronary artery disease(CAD).The proportion of cardiovascular disease in the death rate of residents is higher than 43%.The number one killer of residents,the prevalence and mortality rate is still in a continuous rising stage,and is accelerating the spread to young people.Coronary artery disease mortality accounts for 43% of cardiovascular disease mortality,and 59% of patients are referred to tertiary hospitals.Although the current level of interventional treatment of Coronary artery disease in my country has reached the international advanced level,the mortality rate of Coronary artery disease is still on the rise.The experience of developed countries in Europe and America is to use health management methods to curb the growth of cardiovascular disease prevalence and mortality.my country also attaches great importance to the management of cardiovascular and other chronic diseases,but the existing chronic disease health management model focusing on grassroots in my country has not fully exerted its role in curbing growth in the field of cardiovascular diseases.According to the strategy of Healthy China,the tertiary general hospitals must change their focus and working methods from "health-centered" to "health-centered," especially for the large number of outpatients in tertiary general hospitals.1.Objective:Adhering to the concept of "front-line forward",breaking the traditional model of chronic disease health management mainly studying primary medical institutions and tertiary hospitals mainly studying discharged patients,with the most concentrated and large number of outpatients in tertiary general hospitals as a breakthrough to improve the three For the purpose of the effectiveness of Coronary artery disease health management in first-class general hospitals,relevant strategies and suggestions are proposed to provide ideas for the management of chronic diseases of cardiovascular diseases in third-level general hospitals,with a view to reducing the(re)prevalence and mortality of cardiovascular diseases.2.Methods:(1)A cross-sectional investigation was conducted on 342 outpatients newly diagnosed with stable angina pectoris who were treated in a hospital affiliated to a military medical university from October 2017 to January 2018.Through 36 short items as impact factors,eight dimensions of health-related quality of life(HQRL)were evaluated,including physical function,role limitation caused by physical problems,physical pain,general health,vitality,social function,and role caused by emotional problems Limitations and mental health.The multiple stepwise regression method was used to evaluate the impact of these influencing factors on the patients' quality of life scores,to explore their predictive relationship with Coronary artery disease outpatients,and to focus on the influencing factors that can be intervened.(2)Document analysis method: In order to ensure the safety of medical behavior,the documents of medical intervention content are mainly analyzed by guidelines,expert consensus and other documents,and through database resources such as How Net,Weipu,and the official website of the United Nations Health Organization(WHO).,With "cardiovascular","prevention","health management","exercise","sleep","guide","consensus" as the theme or keywords,conduct a combined search,select the latest version of similar guides.The content analysis method is used to classify the content of the literature one by one,and the intervention content and its advantages and disadvantages are summarized.Use "Chronic Disease Management" as the theme or key search and read it one by one to screen out the effective literature related to the operation intervention;take "Cardiovascular Health Management","Third-level General Hospital","Top Three Hospital" as the theme or keywords Retrieve and read one by one to screen for effective references related to operational interventions.Search through Baidu and search for the topics of "tertiary hospitals" and "health management" to filter out reports on the development of health management in tertiary hospitals.The content analysis method is used to summarize the contents of the literature one by one,and summarize the mode and advantages and disadvantages of the medical intervention carried out by the three-level general hospital.(3)SWOT analysis method: Based on the above research results,according to the intervening factors that affect patients' HRQL and various aspects of health management,list and analyze the opportunities and challenges,existing advantages and disadvantages faced by the tertiary general hospitals,and use the strategy matching method to The matrix method proposes the SO,WO,ST and WT strategy contents of the health management service mode of the three-level general hospital,and selects the items with high repetition rate as the priority strategy suggestions.3.Results:(1)Older,female,inactive,lower education level,lower monthly income,smoking / drinking habits and patients with diabetes,hypertension or hyperlipidemia have lower physiological HRQL scores and physiological health Related to age,sleep quality,exercise habits and monthly income.Those with lower education level and lower monthly income have lower psychological HRQL scores,and their mental health status is related to age,exercise and monthly income.Higher monthly income and regular exercise are associated with higher physical and psychological HRQL scores.The results of multiple stepwise regression analysis show that the physical and mental HRQL is positively correlated with exercise and monthly income,and negatively correlated with age.The HRQL score of patients with monthly income ?5000 yuan is higher than that of patients with monthly income <5000 yuan.Sleep quality and alcohol consumption are negatively correlated with the body's HRQL,but not with the mental HRQL.(2)The intervention contents of medical institutions to intervene in "exercise" and "sleep" :(1)Different cardiovascular guidelines have different emphasis on the description of exercise,mainly divided into the theoretical recommendations of quantitative exercise indicators and intervention content(including quantitative indicators and implementation methods)).The theoretically recommended quantitative indicators are basically consistent with the expressions related to primary prevention of cardiovascular diseases.(2)Exercise-related medical intervention methods mainly include: education-exercise assessment-cardiopulmonary function assessment-risk stratification-exercise prescription-operation prescription principle-implementation of exercise prescription.(3)The focus of the intervention content: Both primary and secondary prevention of CVD are recommended to improve exercise.It is recommended that clinicians provide both drug prescriptions,exercise prescriptions and help improve sleep.Within a certain range,the greater the intensity of exercise,the greater the cardiovascular benefit,but at the same time,the risk of exercise increases.Doctors should pay attention to both exercise risk and the decline of patients' exercise endurance,and take timely measures to improve exercise tolerance.The purpose of exercise intervention is to find the most effective and safe exercise threshold,long-term adherence,dynamic evaluation and optimization.Medical institutions' interventions on cardiovascular diseases are being accepted by everyone,but they still need to be promoted.The exercise and sleep quality of cardiovascular patients need professional evaluation and objective quantification to guide intervention measures.Poor sleep can be either a physical disease or a psychological disease,and different treatment options must be taken in a targeted manner.Sleep,psychology,and exercise have a strong correlation.It can be seen that through the improvement of any factor between psychology,exercise,and sleep,the other two factors can be positively improved.Whether it is exercise intervention or sleep intervention,patients need good compliance.(3)The mode for medical institutions to carry out cardiovascular disease health management:(1)The effective containment of chronic diseases in the United States,Japan,and Finland,starting from comprehensive screening,is due to its strong primary medical system and medical security system,but due to each This reason cannot be promoted in China for the time being.(2)In 1997,China promulgated the "National Comprehensive Plan for the Prevention and Treatment of Chronic Non-communicable Diseases(Trial)" to include cardiovascular disease in the category of chronic disease management.After more than 20 years of exploration,China has gradually formed family contracting,graded diagnosis and treatment,regional medical consortium,Chronic disease comprehensive prevention and control demonstration areas and other systems or service models are generally government-led,with grassroots medical and health institutions as the focus,emphasizing multi-sectoral participation,and basically covering three-level general hospitals,and the management targets are community residents.(3)Due to the failure to straighten out the division and coordination system at all levels and the heavy burden on the government,the promotion of the multi-sectoral participation model is limited.(4)The tertiary general hospital is a chronic disease health management model,mainly targeted at high-risk groups during physical examination,outpatient triage groups and two-way referral groups.Taking into account the functions of general practitioner training and community talent training,it has contributed to the advancement of prevention and control,active transfer and talent training.(5)The cardiovascular management model is based on the health management model developed by the cardiovascular specialty.The target is mainly discharged patients.As a secondary prevention and continuation treatment,the purpose is to improve the patient's treatment control rate,but it will increase the patient's dependence on the tertiary general hospital.Due to the pressure of human resources,it is urgent to strengthen the construction of the medical consortium and the capacity building of grass-roots units to enhance the efficiency of the transfer.(6)The “Cardiac Rehabilitation” center seems to be the most comprehensive cardiovascular disease health management model.The biggest feature is that it requires the establishment of a multidisciplinary medical team,covering exercise prescriptions and psychological(sleep)prescriptions,but in China Development needs to be strengthened.(4)Participating in the medical consortium,using the medical examination center,increasing health management-related publicity,helping the establishment of talents and capabilities in the grassroots units,smoothly transferring mechanisms,and setting up a "cardiac rehabilitation center" are the best ways to carry out cardiovascular health management in outpatient clinics of tertiary hospitals Strategy.4.Conclusion:(1)Exercise,sleep,and income are factors that can interfere with the health-related quality of life of patients with cardiovascular disease.(2)Medical institutions should actively carry out medical interventions for exercise and sleep of patients with cardiovascular diseases.The safety and effectiveness of interventions require multiple professional medical personnel and professional facilities and equipment,and scientific implementation principles can only guarantee them.At the same time,it is necessary to improve the acceptance of patients by various means,and cultivate and improve patient compliance.(3)China's existing chronic disease management model based on the bottom of the grassroots.Due to the limitations of the basic medical institutions' ability and level,the level of exercise sleep intervention for patients with cardiovascular disease is low.In the link of disease health management.(4)The health management model based on the third-level general hospital and the health management model based on the cardiovascular disease specialty can cover exercise and sleep intervention,especially the health clinic of the medical examination center and the health clinic of the cardiovascular specialty,But mainly based on health education,direct assessment and intervention of exercise and sleep are rarely involved,but it can play a good role in health assessment and health education.The ?Cardiac Rehabilitation Center? project in China is currently the most comprehensive,complete,and well-defined health management model for the sports and sleep management team.Although it is mainly aimed at discharged patients,its content is also applicable to outpatients and should be active Carried out and applied to both outpatient and inpatients.(5)The health management of outpatient clinics of tertiary general hospitals can not only focus on the "health intervention" link,but only through the implementation of all aspects of the entire health management can it be effectively implemented.5.Strategy recommendations(1)Use the concept of health management to achieve three-level prevention of cardiovascular diseases.(2)Strengthen residents' awareness of cardiovascular disease health management and publicity and education of graded diagnosis and treatment.(3)Strengthen effective screening and health education for cardiovascular diseases through the physical examination center.(4)Carry out a cardiovascular health clinic centered on the needs of patients.(5)Take the lead in carrying out cardiac rehabilitation,forming a medical consortium,and building a three-level network for cardiac rehabilitation.(6)Establish a general medicine department to be a training cradle for general practitioners and a ferry for two-way referrals.(7)Incorporate cardiovascular health management projects into medical insurance. |
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