@文章{信息:doi/10.2196/15978，作者="邓宁陈娟刘怡远魏硕硕生雷毅陆容王哲宇朱佳荣安继业王贝林惠王秀艳周玉敏段慧龙冉皮欣利用移动医疗技术为中国偏远地区慢性阻塞性肺疾病患者提供社区闭环管理系统:《发展与前瞻性观察研究》，期刊=“JMIR Mhealth Uhealth”，年=“2020”，月=“11月”，日=“25”，量=“8”，数=“11”，页=“e15978”，关键词=“COPD;移动医疗技术;闭环护理路径;慢性病管理;背景:移动健康(mHealth)技术是一种越来越被认可的有效的疾病管理方法，并有可能干预慢性阻塞性肺疾病(COPD)患者的肺功能、加重风险和心理状态。目的:本研究旨在探讨为我国偏远地区潜在COPD患者多、医疗资源有限的地区设计基于健康的COPD管理系统的可行性。方法:系统采用量身定制的闭环护理路径，将繁重的管理任务分解成细节，由计算机量化执行。低成本COPD评估和基于问卷的心理干预是该途径的2个主要特点。在社区层面进行了为期6个月的前瞻性观察研究，以评估该系统的效果。 Primary outcomes included changes in peak expiratory flow values, quality of life measured using the COPD assessment test scale, and psychological condition. Acute exacerbations, compliance, and adverse events were also measured during the study. Compliance was defined as the ratio of the actual frequency of self-monitoring records to the prescribed number. Results: A total of 56 patients was enrolled; 39 patients completed the 6-month study. There was no significant difference in the mean peak expiratory flow value before and after the 6-month period (366.1, SD 106.7 versus 313.1, SD 116.6; P=.11). Psychological condition significantly improved after 6 months, especially for depression, as measured using the Patient Health Questionnaire-9 scale (median 6.0, IQR 3.0-9.0 versus median 4.0, IQR 0.0-6.0; P=.001). The COPD assessment test score after 6 months of intervention was also lower than that at the baseline, and the difference was significant (median 4.0, IQR 1.0-6.0 versus median 3.0, IQR 0.0-6.0; P=.003). The median overall compliance was 91.1{\%} (IQR 67{\%}-100{\%}). In terms of acute exacerbation, 110 exacerbations were detected and confirmed by health care providers (per 6 months, median 2.0, IQR 1.0-5.0). Moreover, 72 adverse events occurred during the study, including 1 death, 19 hospitalizations, and 52 clinic visits due to persistent respiratory symptoms. Conclusions: We designed and validated a feasible mHealth-based method to manage COPD in remote Chinese areas with limited medical resources. The proposed closed-loop care pathway was effective at the community level. Proper education and frequent communication with health care providers may encourage patients' acceptance and use of smartphones to support COPD self-management. In addition, WeChat might play an important role in improving patient compliance and psychological distress. Further research might explore the effect of such systems on a larger scale and at a higher evidence level. ", issn="2291-5222", doi="10.2196/15978", url="http://mhealth.www.mybigtv.com/2020/11/e15978/", url="https://doi.org/10.2196/15978", url="http://www.ncbi.nlm.nih.gov/pubmed/33237036" }