García-Sáez Gema, Rigla Mercedes, Martínez-Sarriegui Iñaki, Shalom Erez, Peleg Mor, Broens Tom, Pons Belén, Caballero-Ruíz Estefanía, Gómez Enrique J, Hernando M Elena
Bioengineering and Telemedicine Centre, Universidad Politécnica de Madrid, Spain CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain
Endocrinology and Nutrition Department Parc Tauli Sabadell University Hospital, Sabadell, Spain.
J Diabetes Sci Technol. 2014 Mar;8(2):238-246. doi: 10.1177/1932296814526492. Epub 2014 Mar 6.
The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients' self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient's access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients' personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients' acceptance of the whole system.
通过能够改善血糖控制的积极治疗，可以降低与妊娠期糖尿病（GD）相关的风险。移动健康领域的进展可为GD提供以患者为中心的新模式，以创建个性化医疗服务，增强患者独立性并提高患者的自我管理能力，并有可能改善他们的治疗依从性。在这些模式中，决策支持功能起着至关重要的作用。远程医疗系统MobiGuide为GD患者提供基于计算机化临床指南并适用于移动环境的个性化医疗决策支持。基于智能手机的应用程序支持患者访问该系统，提高了系统的效率和易用性。我们将GD指南形式化为计算机可解释指南（CIG）。我们确定了几种为患者提供决策支持功能的工作流程，以及4种将通过家庭移动应用程序提供的个性化建议，这是在远程医疗系统中提供决策支持工具的初步步骤：（1）治疗，帮助患者遵守医嘱；（2）监测，帮助患者遵守监测指示；（3）临床评估，告知患者其健康状况；（4）即将发生的事件，处理患者的个人情况或特殊事件。指定面向患者的决策支持功能的整个过程可确保其基于GD临床指南中包含的知识，从而遵循循证建议，但同时以患者为导向，这可以提高临床效果和患者对整个系统的接受度。
