目的旨在通过在上海市嘉定区和宝山区构建分级诊疗模式并进行无症状性血尿患儿分级诊疗实践性研究,探索和完善“上海市学校尿液筛查网络化建设”的有效模式。方法 2013—2014年,由复旦大学附属儿科医院牵头,通过疾病筛查监测网络构建、相关临床数据信息化管理、人才队伍建设和区级医院开设专病门诊等三方面在上海市嘉定区和宝山区试点建立分级诊疗模式,并对这两个区在学校尿液筛查中发现的隐血或蛋白尿(本研究不对蛋白尿者进行分析)学生实施无症状性血尿分级诊疗。结果分级诊疗的构建:形成由上海市嘉定区和宝山区学校尿液筛查机构(一级)、上海市嘉定区中心医院和上海市宝山区中西医结合医院(二级)、复旦大学附属儿科医院(三级)构建的疾病筛查监测网络;开发并应用互联网尿液筛查数据库,对在区级医院和复旦大学附属儿科医院就诊/随访学生的临床资料进行信息化管理,并定期进行质量控制检查;协助区级医院组建儿童肾脏病诊疗队伍和开设尿液筛查专病门诊。分级诊疗的实践:共筛查上海市嘉定区和宝山区20所初中4 930名学生,发现隐血和(或)蛋白尿70例(1.42%,70/4 930);区级医院首诊69例(首诊率为98.6%,69/70);达到复旦大学附属儿科医院转诊标准2例,实际转诊1例(1/2),经评估为单纯性镜下血尿转回区级医院随访;区级医院单纯性镜下血尿随访20例(100.0%,20/20)。信息化管理:对上海市嘉定区中心医院和上海市宝山区中西医结合医院的相关临床数据进行信息化管理,综合数据登记系统和电子登记表,信息化管理达到100%。结论无症状性血尿分级诊疗的可行性强,能提高学校尿液筛查异常者的就诊率和随访率,是实现上海市学校尿液筛查网络化建设的有效模式,有望成为儿童慢性肾脏病二级预防的有力手段。区级医院儿科医师经过专科培训后可以承担当地儿童肾脏疾病常见症状的诊疗任务,在分级诊疗实行中发挥重要作用。 The purpose of this project is to explore and improve the effective mode of “Shanghai School Urine Screening Network” through the construction of a hierarchical diagnosis and treatment model in Jiading District and Baoshan District of Shanghai and practical research on the grading of patients with asymptomatic hematuria . Methods From 2013 to 2014, led by the Pediatric Hospital affiliated to Fudan University, through the construction of disease screening monitoring network, the management of relevant clinical data, the construction of talent pool and the establishment of special disease clinics in district-level hospitals in Shanghai Jiading District and Baoshan The district pilot established a hierarchical diagnosis and treatment model and conducted students’ clinical treatment of asymptomatic hematuria by examining occult blood or proteinuria found in school urine screening (the study did not analyze proteinuria). Results Grading diagnosis and treatment of the formation: formed by the Shanghai Jiading District and Baoshan District School Urine Screening (a), Shanghai Jiading District Central Hospital and Shanghai Baoshan District Hospital of Integrated Traditional and Western Medicine (two), Fudan University, Pediatrics Hospital (three) to build a disease screening monitoring network; development and application of the Internet urine screening database, the clinical information of the visiting / visiting students in the district hospitals and affiliated pediatric hospitals in Fudan University, information management, and regular quality Control inspection; to help district-level hospitals to set up a pediatric kidney disease diagnosis and treatment team and set up a urine screening specialist clinic. The practice of grading diagnosis and treatment: A total of 4 930 students from 20 junior high schools in Jiading District and Baoshan District of Shanghai were screened, and 70 patients (1.42%, 70/4930) of occult blood and / or proteinuria were found; 69 patients (The first visit rate was 98.6%, 69/70) .There were 2 referral criteria of Fudan University Pediatric Hospital and 1 actual referral (1/2). The patients were evaluated as simple microscopic hematuria returned to district hospital follow-up 20 cases (100.0%, 20/20) were followed up for simple microscopic hematuria in district hospitals. Information Management: Information management of the relevant clinical data of Shanghai Jiading District Central Hospital and Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, comprehensive data registration system and electronic registration form, information management reached 100%. Conclusion Asymptomatic hematuria grading is highly feasible and can improve the visiting rate and follow-up rate of urine screening in schools. It is an effective model to realize the urinalysis screening network in Shanghai. It is expected to become a chronic kidney disease in children Secondary prevention of powerful means. District hospital pediatricians after specialist training can bear the common symptoms of children with kidney disease diagnosis and treatment tasks, in the implementation of grading diagnosis and treatment play an important role.