乳腺癌患者全病程管理信息系统的开发与应用研究

doi:10.3761/j.issn.0254-1769.2024.08.001

摘要/Abstract

摘要：

目的开发乳腺癌患者全病程管理信息系统并验证其在患者疾病管理中的应用效果。方法制订“筛查-诊断-治疗-康复”为一体的整合型服务方案，开发可供全病程管理的信息系统。采用历史对照研究，便利抽取南京市某三级甲等医院确诊的乳腺癌患者260例作为应用对象，将2022年5月1日—12月31日确诊的130例作为试验组，采用全病程管理信息系统进行管理；2021年5月1日—12月31日确诊的130例作为对照组，采用常规疾病管理。比较两组筛查诊断期相关指标、治疗完成率、治疗相关副作用发生率及患者癌症照护满意度情况。结果试验组脱落4例，对照组脱落7例。两组穿刺等待时间、入院等待时间、筛查-入院时间比较，差异有统计学意义（P<0.05），两组病理等待时间比较，差异没有统计学意义（P>0.05）。试验组的治疗完成率高于对照组，差异具有统计学意义（P<0.05）；且试验组术后6个月内患侧上肢淋巴水肿、胸痹及上肢感觉异常、皮下积液情况以及辅助治疗骨髓抑制、肝功能损害、放射性皮炎、放射性肺炎的发生率均小于对照组，差异具有统计学意义（P<0.05）；试验组术后及术后6个月的癌症照护满意度均高于对照组，差异具有统计学意义（P<0.05）。结论应用乳腺癌患者全病程管理信息系统可优化诊疗流程、提高诊疗效率，保障乳腺癌患者治疗完成率，减少其治疗并发症，提高其癌症照护满意度。

关键词: 乳腺癌, 个案管理, 全病程管理, 互联网干预, 护理

Abstract:

Objective To develop a whole course management information system for breast cancer and verify its effect in disease management of breast cancer patients. Methods An integrated service plan and system construction of "screening-diagnosis-treatment-rehabilitation" was developed，and then an information system was developed. The method of historical control was used to conveniently sample 260 cases of breast cancer patients diagnosed in a tertiary A hospital. 130 cases diagnosed from May 1 to December 31，2022 were taken as a test group，and 130 cases diagnosed from May 1 to December 31，2021 were taken as a control group. The test group was managed by the whole course management information system，and the control group was managed by conventional disease management. The relevant indicators of the screening and diagnosis period of patients，the completion rate of treatment，the incidence of treatment related side effects and the cancer care satisfaction of the 2 groups were compared. Results There was a statistically significant difference in puncture waiting time，admission waiting time，and screening admission time between the 2 groups（P<0.05），while there was no statistically significant difference in pathological waiting time（P>0.05）. The treatment completion rate of the test group was higher（P<0.05）. The incidence of lymphedema，chest obstruction and abnormal sensation of upper limbs，subcutaneous hydrops within 6 months after operation and bone marrow suppression，liver function damage，radiation dermatitis and radiation pneumonia in the test group were lower than those in the control group（P<0.05）. The cancer care satisfaction of the test group after surgery and 6 months after surgery were higher than those of the control group（P<0.05）. Conclusion The whole course management information system for breast cancer can optimize the diagnosis and treatment process，raise the diagnosis and treatment efficiency，ensure the treatment completion rate，reduce the treatment complications and improve the cancer care satisfaction.

Key words: Breast Neoplasms, Case Management, Whole Course Management, Internet-Based Intervention, Nursing Care

郭苗苗, 严婷婷, 许丹丹, 袁玲. 乳腺癌患者全病程管理信息系统的开发与应用研究[J]. 中华护理杂志, 2024, 59(8): 901-908.

GUO Miaomiao, YAN Tingting, XU Dandan, YUAN Ling. Development and application of a whole course management information system for breast cancer[J]. Chinese Journal of Nursing, 2024, 59(8): 901-908.

图/表 6

图1 乳腺癌患者全病程管理流程

Figure 1 The whole course management service path for breast cancer

图2 乳腺癌患者全病程管理信息系统架构

Figure 2 Structure of the whole course management information system for breast cancer

表1 两组一般资料的比较[例（百分比，%）]

Table 1 Comparison of general data between 2 groups[case（percentage，%）]

表2 两组穿刺等待、病理等待、入院等待、筛查-入院时间比较[d，M（P25，P75）]

Table 2 Comparison of puncture waiting，clear diagnosis，admission appointment time between 2 groups[d，M（P25，P75）]

表3 两组治疗完成率及治疗相关副作用的比较[例（百分率，%）]

Table 3 Comparison of treatment completion rate and treatment related side effects between 2 groups[case（percentage，%）]

表4 两组癌症照护满意度的比较（分，$\bar{x}±s$）

Table 4 Comparison of cancer care satisfaction between 2 groups（scores，$\bar{x}±s$）

参考文献 18

[1]	Zhang S, Sun K, Zheng R, et al. Cancer incidence and mortality in China,2015[J]. J Natl Compr Canc Ne, 2021, 1(1):2-11
[2]	黄利虹. 中国乳腺癌个案管理模式专家共识[J]. 中华医学杂志, 2020, 100(7):493-497.
	Huang LH. Expert consensus on case management model of breast cancer in China[J]. Natl Med J Chin, 2020, 100(7):493-497.
[3]	Yu L, Li P, Yang S, et al. Web-based decision aids to support breast cancer screening decisions:systematic review and meta-analysis[J]. J Comp Eff Res, 2020, 9(14):985-1002. DOI URL
[4]	郭苗苗, 李善萍, 严婷婷, 等. 基于“互联网+”的护理干预对癌症幸存者生活质量影响的荟萃分析[J]. 临床与病理杂志, 2023, 43(3):612-622.
	Guo MM, Li SP, Yan TT, et al. Effects of internet + nursing interventions on quality of life for cancer survivors:a meta-analysis[J]. J Clin Pathol Res, 2023, 43(3):612-622.
[5]	蒋璐璐, 王喜益, 徐洁慧, 等. 智能交互式护理信息支持系统的构建及在乳腺癌患者中的应用研究[J]. 中华护理杂志, 2023, 58(6):654-661. DOI URL
	Jiang LL, Wang XY, Xu JH, et al. Construction of an intelligent interactive nursing information support system and its application in young breast cancer survivors[J]. Chin J Nurs, 2023, 58(6):654-661. DOI URL
[6]	王雪瑞, 陈雁, 王清, 等. 基于服务质量差距模型的“互联网+护理服务”质量评价指标研究[J]. 中华护理杂志, 2021, 56(9):1369-1376. DOI URL
	Wang XR, Chen Y, Wang Q, et al. Construction of a service quality evaluation index system for internet nursing service based on service quality gap model[J]. Chin J Nurs, 2021, 56(9):1369-1376. DOI URL
[7]	国家癌症中心. 《肿瘤诊疗质量提升动计划实施案》[EB/OL]. (2020-04-01)[2022-01-19]. http://www.chinancpcn.org.cn.
	National Cancer Center. Implementation plan for improving the quality of cancer diagnosis and treatment[EB/OL]. (2020-04-01)[2022-01-19]. http://www.chinancpcn.org.cn.
[8]	罗春燕. 疾病管理理论在我国的应用前景[J]. 中国卫生资源, 2000, 3(3):122-124.
	Luo CY. The application prospective of disease management in China[J]. Chin Health Res, 2000, 3(3):122-124.
[9]	中国研究型医院学会乳腺专业委员会中国女性乳腺癌筛查指南制定专家组. 中国女性乳腺癌筛查指南(2022年版)[J]. 中国研究型医院, 2022, 9(2):6-13.
	Expert Group of Breast Cancer Screening Guideline for Chi-nese Women,Breast Committee of Chinese Research Hospital Association. Breast cancer screening guideline for Chinese women(version 2022)[J]. Chin Res Hosp, 2022, 9(2):6-13.
[10]	练敏, 束睿, 李秀, 等. 高级执业护师在中国发展的必要性与实践探索[J]. 中华护理杂志, 2018, 53(5):597-600.
	Lian M, Shu R, Li X, et al. The feasibility and practice of nurse practitioner in China[J]. Chin J Nurs, 2018, 53(5):597-600.
[11]	Mcniel DE, Greenfield TK, Attkisson CC, et al. Factor structure of a brief symptom checklist for acute psychiatric inpatients[J]. J Clin Psychol, 1989, 45(1):66-72. PMID
[12]	张雪, 陈华英, 吴绍勇. 多学科团队全程管理模式建立门诊乳腺癌绿色通道的实践[J]. 西南国防医药, 2020, 30(5):479-482.
	Zhang X, Chen HY, Wu SY. Practice of establishing a green channel for outpatient breast cancer based on the whole course management model of multidisciplinary team[J]. Med J Nat Defen For SW Chin, 2020, 30(5):479-482.
[13]	Vale DB, Filho CC, Shinzato JY, et al. Downstaging in opportunistic breast cancer screening in Brazil:a temporal trend analysis[J]. BMC Cancer, 2019, 19(1):432-438. DOI
[14]	黄静, 吴凡, 陈木兰, 等. 乳腺癌新辅助化疗患者依从性的单中心回顾性研究[J]. 中国临床药理学杂志, 2021, 37(2):107-110.
	Huang J, Wu F, Chen ML, et al. Actual compliance with neoadjuvant chemotherapy in breast cancer:a retrospective single-center analysis[J]. Chin J Clin Pharmacol, 2021, 37(2):107-110.
[15]	Mamishin K, Naito Y, Nomura S, et al. Comparison of treatment completion rate between conventional and dose-dense doxorubicin and cyclophosphamide(AC) followed by a taxane in patients with breast cancer:a propensity score-matched analysis[J]. Anticancer Res, 2021, 41(12):6217-6224. DOI PMID
[16]	Bu X, Jin C, Fan R, et al. Unmet needs of 1210 Chinese breast cancer survivors and associated factors:a multicentre cross sectional study[J]. BMC Cancer, 2022, 22(1):1-14. DOI
[17]	潘宸, 杨林宁, 杨艳. 乳腺癌患者健康信息需求的研究进展[J]. 中华护理杂志, 2022, 57(20):2547-2554. DOI URL
	Pan C, Yang LN, Yang Y. Research progress on health information needs of breast cancer patients[J]. Chin J Nurs, 2022, 57(20):2547-2554. DOI URL
[18]	蒋向玲, 陈春兰. 肿瘤单病种个案管理全病程服务模式的建立与实践[J]. 护理学报, 2022, 29(13):32-34.