城市社区高血压临床路径的研制及双向转诊机制的建立

目的开发研制适合我国城市社区人群高血压的临床路径。方法采用文献法、专家会议法、现场考察和预试验的方法，研制中国城市社区人群的高血压临床路径。结果建立高血压的社区照顾路径、单纯高血压专科诊疗路径、高血压社区-专科双向转诊技术路径和社区-专科双向转诊管理路径。结论高血压的临床路径是以循证医学为指导，既强调了诊疗服务的标准化和规范化，又突出了全科医学连续性照顾的特点。

Development of Clinical Pathway of Hypertension and Clinical Two-way Referral Mechanism in Urban Community

Objective To develop the clinical pathways in urban community for the patients with hypertension.Methods The clinical pathways in urban community for hypertension were developed by literature retrieval and review,expert discussion,field observation and preliminary test.Results The clinical pathways for hypertension were developed,including the clinical pathway for hypertension in community,the clinical pathway for hypertension without complication in hospital,the clinical two-way referral technical pathway and the clinical two-way referral management pathway between community health care service centers and hospitals for hypertension.Conclusion Directed by evidence based medicine,the clinical pathways for hypertension could not only emphasize the standardization of the medical care service,but also stress the characteristics of continuity care of general practice.