Studies on the system construction to ensure the quality of medical care in the practice of chronic obstructive pulmonary disease

本研究采用标准化的临床路径作为保证COPD患者护理质量的一种手段。我们通过结构化专家医生的特定经验和知识，基于PCAPS(患者条件自适应路径系统)开发了针对COPD患者的电子标准护理流程。为了直观地了解各医疗机构治疗方案的差异，我们调查了COPD恶化的治疗内容，并对差异进行了基准比较。我们发现，在努力治疗感染或肺康复开始缓慢时，有延长住院时间的趋势。我们就COPD的临床实践对初级保健医生进行了调查。对于初级保健医生来说，通过肺活量测定确诊慢性阻塞性肺疾病和处理病情恶化是困难的。我们需要一个支持系统，为初级保健医生提供肺活量测定服务，并为COPD的恶化提供支持。

This study was used clinical pathway, which is standardized as a means to ensure the quality of care in COPD. We develop electronic standard care process for patients of COPD based on PCAPS (Patient Conditions Adaptive Path System) by structuralizing the particular experience and knowledge of expert physicians. To visualize the differences between the therapeutic regimens of each medical institution, we investigate the content of treatment of COPD exacerbations, and did benchmark comparison the difference. We found that there is a tendency for prolongedhospitalization when it is struggling to treatment of infection, or if the start ofpulmonary rehabilitation is slow. We surveyed the primary care physicians in regard to the clinical practice of COPD. Confirmed diagnosis of COPD by spirometry and management of exacerbations are difficult for primary care physicians. We need a supporting system for primary care physicians to provide spirometry service and to backup for exacerbation of COPD.