Introduction
Methods
Setting and participants
Cloud follow-up group
Establishment of a multidisciplinary treatment (MDT) team for cloud follow-up
Construction of the cloud follow-up platform
Category | Functional module | Specific functions | Function description |
---|---|---|---|
PC-based doctor-patient collaboration platform | Patient management | Patient grouping | After the doctor issues the discharge order, the cloud follow-up platform automatically adds the patient to the cloud follow-up list |
Personality management | Includes health records (such as basic personal information, medical history information, number maintenance, information entry, lifestyle, and laboratory indicators); business records (such as health education records, follow-up form records, short message records, follow-up records, and abnormal monitoring); health records (such as diet records, chemotherapy complications records) | ||
Knowledge base management | Health education resources | It contains 13 special health education materials for gynecological chemotherapy patients in the form of video, PowerPoint slides, and text. | |
Propaganda rule base | Chemotherapy patients started from the day of discharge, followed by a special health education every week on a total of 13 topics. | ||
Follow-up form resources | Questionnaire on adverse reactions of chemotherapy (including nausea, vomiting, sleep, constipation, diarrhea, deep venous thrombosis, fatigue) | ||
Follow-up rule base | Follow-up forms will be pushed 2 days, 1 week, and 2 weeks after discharge. | ||
Reminder phrase resources | Set phrases to remind patients of precautions | ||
Follow-up center | Follow-up plan | Make a follow-up plan. Medical staff can view the total follow-up personnel, personnel to be followed up, personnel who have been followed up, and overdue follow-up personnel | |
Statistical center | Statistical function | Automatically count the reading of each health education theme and the specific filling of each follow-up form and summarize and export the data | |
Medical App | Health information | Health information | Medical staff can view the patient’s adverse reaction records of chemotherapy online and the patient’s examination report, laboratory test report, follow-up form, etc. |
Doctor-patient interaction | Doctor-patient interaction | Medical staff can monitor the abnormal health information, inspection results, and follow-up results of patients, communicate and interact with patients in real-time, answer patients’ problems in real-time, provide health education and guidance, and realize remote nursing services. | |
Patient App | Household graded management | Graded management of chemotherapy complications | Graded management is carried out according to the severity of adverse reactions after chemotherapy. |
Consulting service | Consulting service | Provide online interaction for patients. Patients can leave messages in the form of text, pictures, videos, and voice messages or contact medical staff online to solve the problems existing in home care remotely. | |
Health monitoring | Medical information | Patients can view medical records, examination reports, and laboratory test reports synchronously through the App. | |
Personal settings | Personal settings | Patients can set personal information, medication reminders, follow-up reminders, etc. | |
WeChat official account | Health education and follow-up | The cloud follow-up platform pushes messages through the open interface of the WeChat public platform. After the patients connected with the WeChat official account, the health education materials and follow-up questionnaires were directly pushed to the main interface of the WeChat official account. Patients used this to acquire knowledge about the disease and fill in the follow-up questionnaires at any time during the daily use of WeChat. |
Implementation of the cloud follow-up platform
Establishing patient-specific files
Specialized follow-up and health education
Parameter | Information |
---|---|
Basic information | Patient name, age, diagnosis, registration number, cancer stage, chemotherapy course, and discharge date a |
Dialogue result | The patient completed the follow-up form |
Follow-up form duration (s) | 221 |
Question 1 score | 5 |
Question 2 score | 0 |
Question 3 score | 0 |
Question 4 score | 0 |
Question 5 score | 0 |
Question 6 score | 0 |
Question 7 score | 0 |
Question 8 score | 5 |
Total score | 10 |
Number of options abnormal | 2 |
Number of times of medical treatment reminded | 1 |
Number of health education materials pushed | 1 |
Follow-up date | 2021/5/4 |
System: Dear gynecological patients receiving chemotherapy, to promptly understand your condition at home and provide guidance and help, can you spend a few minutes on a follow-up survey? |
Patient: OK. |
System: Have you experienced nausea in the past 24 h? |
Patient: Yes. |
The system will automatically pop up related sub-questions about nausea. |
System: Please select the degree of nausea you have experienced in the past 24 h. |
○Loss of appetite but not reduced food intake |
○Reduced food intake without significant weight loss and malnutrition |
○Eating significantly decreased, and physical weakness appeared |
If the patient selected the third case, the system automatically popped up the red words “Please see a doctor as soon as possible.” |
System: Have you vomited in the past 24 h? |
Patient: No. |
If the patient selected no, the system automatically popped up the next question. |
System: Have you had constipation in the past week? |
Patient: No. |
System: Have you had diarrhea in the past 24 h? (stool is thin and more than three times/day) |
Patient: No. |
System: Have you felt tired and weak in the past 24 h? |
Patient: No. |
System: Were you satisfied with the quality of your sleep in the last week? |
Patient: Yes |
System: Have you had limb swelling, pain, numbness, chest tightness, or polypnea in the past 24 h? |
Patient: No. |
System: Can you correctly do finger exercises and ankle pump exercise training to prevent thrombosis? |
Patient: No. |
The system automatically popped up the health education video of finger manipulation and ankle pump movement. |
After answering all the questions, click submit. |
System: Thank you for your cooperation. We have recorded your problem. Please handle it according to the system prompt, keep the phone unobstructed, and we will follow you if necessary. |
Household graded management
Health monitoring
Manual follow-up group
Data collection
Assessment indicators
Statistical analysis
Results
Patients’ characteristics
Characteristics | Cloud follow-up group, n (%) | Manual follow-up group, n (%) | Chi-square (df) | P value |
---|---|---|---|---|
Number of patients | 2538(100) | 690(100) | ||
Age (years) | 0.54(3) | 0.91 | ||
<40 | 337 (13.3) | 96(13.9) | ||
40–49 | 769 (30.3) | 215(31.2) | ||
50–59 | 898 (35.4) | 236(34.2) | ||
≥ 60 | 534 (20.0) | 143(20.7) | ||
Education | ||||
<High school | 992(39.1) | 267(38.7) | 0.04(1) | 0.85 |
≥ High school | 1546(60.9) | 423(61.3) | ||
Cancer stage | 3.50(3) | 0.32 | ||
I | 302(11.9) | 90(13.0) | ||
II | 783(30.9) | 196(28.4) | ||
III | 822(32.4) | 214(31.0) | ||
IV | 631(24.9) | 190(27.6) | ||
Disease category | 2.90(5) | 0.72 | ||
Cervical carcinoma | 822(32.4) | 235(34.1) | ||
Ovarian cancer | 655(25.8) | 181(26.2) | ||
Endometrial cancer | 700(27.6) | 173(25.1) | ||
Gestational trophoblastic tumor | 122(4.8) | 39(5.6) | ||
Vulvar carcinoma | 107(4.2) | 30(4.4) | ||
Other | 132(5.2) | 32(4.6) |
Cost-effectiveness
Indicators | Cloud follow-up | Manual follow-up | Chi-square (df) | P value |
---|---|---|---|---|
Follow-up | 2.36 (1) | 0.13 | ||
Number of effective follow-ups | 6957 | 1869 | ||
Number of invalid follow-ups | 657 | 201 | ||
Follow-up rate, % | 91.4 | 90.3 | ||
Satisfaction | 764.31(2) | <0.001 | ||
Number of very satisfied | 4327 | 887 | ||
Number of satisfied | 2865 | 645 | ||
Number of total actual follow-up cases | 7614 | 2070 | ||
Follow-up service satisfaction, % | 94.5 | 74.0 | ||
Time spent, hours per 100 patients | 1.2 | 10.5 | N/Aa | N/A |
Variable | Multivariable logistic regression model (Satisfaction) | Multiple linear regression model (Time spent) | ||
---|---|---|---|---|
Odds ratio | 95%CI | Coefficient | 95%CI | |
Cloud follow-up (reference group = manual follow-up) | 2.239* | 1.237 ~ 5.219 | -9.287** | -1.439~-0.165 |
Age (reference group = age < 40) | 0.428 | 0.287 ~ 1.298 | 1.021 | -0.429 ~ 2.019 |
Education (reference group = < high school | 1.219 | 0.897 ~ 2.123 | -0.876* | -0.823~-0.486 |
Cancer stage (reference group = cancer stage < IV) | 0.639 | 0.329 ~ 1.439 | 0.927 | -0.540 ~ 1.329 |
Disease category (reference group = cervical carcinoma) | 1.232 | 0.532 ~ 2.987 | 0.489 | -0.829 ~ 2.287 |
Likelihood ratio test for model | Chi-square = 18.21; P = 0.012 | Chi-square = 25.23; P = 0.008 R squared = 0.311 |
Pushing and reading thematic health education materials on the cloud follow-up platform
Health education theme | Sending times | Read times | Read rate (%) |
---|---|---|---|
Diet, nutrition, and patients receiving chemotherapy | 10,152 | 9827 | 96.8 |
Management of nausea and vomiting in patients receiving chemotherapy | 20,137 | 17,357 | 86.2 |
Management of constipation in patients receiving chemotherapy | 19,827 | 16,778 | 84.6 |
Drug treatment and adverse reactions in patients with gynecological tumors | 10,152 | 8558 | 84.3 |
Sleep management of patients receiving chemotherapy | 17,998 | 15,056 | 83.7 |
Home care in PICC and infusion port | 10,152 | 7956 | 78.4 |
Fatigue management of patients receiving chemotherapy | 18,267 | 14,224 | 77.9 |
Management of diarrhea in patients receiving chemotherapy | 11,298 | 7657 | 67.8 |
Prevention of thrombosis in patients receiving chemotherapy | 10,998 | 7213 | 65.6 |
Diagnosis and management of gynecological tumors | 10,672 | 6987 | 64.5 |
Prevention and management of CIPN | 11,267 | 6134 | 54.4 |
Fertility related matters of patients receiving chemotherapy | 9628 | 3897 | 40.5 |
Guidelines for adolescent gynecological patients receiving chemotherapy | 9826 | 3445 | 35.1 |
Total | 170,374 | 124,189 | 72.9 |