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目的 开发研制适合我国城市社区人群冠心病的临床路径。方法 采用文献法、专家会议法、现场考察和预试验的方法, 研制中国城市社区人群的冠心病临床路径。结果 建立了冠心病的社区照顾路径、冠心病的专科诊疗流程、急性心肌梗死专科诊疗路径、不稳定型心绞痛专科诊疗路径、冠心病社区-专科双向转诊技术路径和社区-专科双向转诊管理路径。结论 冠心病的临床路径是以社区慢性病照顾为切入点, 以循证医学为指导, 突出以病人为中心和以照顾的连续性为方向的一组环行路径。
Objective To develop a clinical path suitable for coronary heart disease in urban communities in China. Methods The clinical pathway of coronary heart disease in Chinese urban community population was developed using the methods of literature review, expert conference, field investigation and pretest. Results The community-based care pathways of CHD, specialist diagnosis and treatment of coronary heart disease, pathways of acute myocardial infarction, pathways of unstable angina, pathways of community-specific two-way referral and community-specialist bidirectional referral management of coronary heart disease path. Conclusion The clinical path of coronary heart disease is based on taking care of community chronic diseases. Guided by evidence-based medicine, a set of circular pathways centered on the patient and on the continuity of care are highlighted.