移动互联网信息平台在慢性阻塞性肺疾病分级诊疗中的应用效果研究

目的　建立慢性阻塞性肺疾病（COPD）分级诊疗移动互联网信息平台（D2P-COPD平台），探讨其在COPD分级诊疗中的应用效果。方法　选取2017-11-01至2018-01-31松江区15家社区卫生服务中心经过初筛和肺功能检查确诊的COPD患者为观察组，依据D2P-COPD平台予以综合评估，制定规范的治疗方案。选取2014年4—7月在松江区5家社区卫生服务中心经社区全科医生通过肺功能检查诊断的173例COPD患者为对照组，均随访1年。分析两组患者诊断和治疗情况，比较两组患者的治疗率和规范治疗率。结果　通过D2P-COPD平台，经过初筛及肺功能检查，218例确诊为COPD，肺功能分级：GOLD 1级18例，GOLD 2级104例，GOLD 3级59例，GOLD 4级51例。观察组患者治疗率为47.7%（104/218），与对照组的40.3%（64/173）比较，差异无统计学意义（χ2=2.068，P=0.150）。观察组患者规范治疗率高于对照组（χ2=65.447，P<0.001）。结论　D2P-COPD平台适用于COPD分级诊疗，社区全科医生可以通过筛查量表进行COPD筛查，提高COPD早期诊断率；D2P-COPD平台也可以提高社区全科医生COPD药物的规范治疗化率。

Role of Smartphone-based D2P-COPD Platform in the Hierarchical Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease

Objective　To develop a smartphone-based D2P-COPD platform and to explore its role in the hierarchical diagnosis and treatment of COPD.Methods　This study was conducted in community health centers（CHCs） in Shanghai's Songjiang District，among the patients used smartphone-based D2P-COPD platform for the management of stable COPD sampled from 15 CHCs between November 1，2017 and January 31，2018 （observation group），and those who did not use it sampled from 5 CHCs between April and July 2014 （control group，n=173）．The diagnosis，rates of receiving treatment and standardized treatment during a period of one year follow-up were compared between the two groups.Results　In the observation group，218 were diagnosed with COPD by the community general practitioner using the D2P-COPD platform.The GOLD classification for COPD for them was as follows：18 were in grade 1 stage，104 were in grade 2 stage，59 were in grade 3 stage，and 51 were in grade 4 stage.There was no significant difference in the rate of receiving treatment between observation group and the control group〔47.7%（104/218）vs 40.3%（64/173）〕（χ2=2.068，P=0.150）．Moreover，the rate of receiving standardized treatment was also higher in the observation group than that of the control group（χ2=65.447，P<0.001）．Conclusion　The smartphone-based D2P-COPD platform is suitable for the hierarchical diagnosis and treatment of COPD.The D2P-COPD screening scale provided by the platform can be used by the community general practitioners（CGPs） for COPD screening，which is contributive to the early diagnosis of COPD.Furthermore，the platform-aided assessment of the patient's conditions helps to improve the rate of standardized pharmacologic treatment prescribed by the CGPs.