網際網路服務應用於心血管疾病患者之風險評估與監控

A Web-Based Self Risk Assessment and Monitoring Service For Patients with Cardiovascular Disease

近年來，由於人口老化及生活型態的改變，罹患慢性疾病型態的人口也逐年增加，然而目前對於慢性病的風險評估與監控的資訊系統卻不多見。本論文以心血管疾病(Cardiovascular diseases - CVD)此類慢性病作為研究對象，提出一套建構在網際網路上之風險評估與監控系統，基於網際網路的普及與隨時隨地可用性，期能增進慢性病的防治成效。心血管疾病已成為危害世界各國民眾健康的嚴重疾病，其中，冠狀動脈心臟病(Coronary Heart Disease - CHD)與中風(Stroke)是最主要，且最嚴重心血管疾病型態，心血管疾病除了對個人的健康產生嚴重威脅，更間接影響國家醫療保健的支出，關於心血管疾病議題，是值得衛生醫療單位及民眾重視和關心的。罹患心血管疾病可經由多個危險因子加以判斷，而改善這些危險因子可獲得有效的心血管疾病防治。有許多的相關研究提出心血管疾病的危險因子群，然而這些研究大多以國外的人口為研究基礎，對於台灣的人口未必適合，因此本論文的目的在於檢視相關研究所提出之心血管疾病危險因子，同時根據這些危險因子，取得適用台灣民眾的風險評估模式，最後以此模式開發適當的資訊系統，以防治及改善心血管疾病的高危險群的風險。我們針對心血管疾病病人及高風險群民眾，發展出一套遠距居家照護與健康促進的資訊系統，建構在網際網路服務之解決方案，提供兩階段的防治機制：初級預防階段著重在心血管疾病的風險評估，旨在篩選出高危險群的患者；次級預防階段旨在追蹤及監督心血管患者的服從及改善情況。提供個人化有效即時的衛教計劃及定期的生理數據收集，並且進行風險評估以達到健康管理及監控等疾病預防措施，使未發病的民眾及早診斷與治療，減少罹病率，協助已確診的病患減少併發症的發生，進一步降低死亡率，提高生活品質，降低社會健康成本，以期達到活得健康，活得更久的最終目的。

Recently, cardiovascular disease (CVD) has become one of the most prevalent causes of morbidity and mortality in many countries. Especially in Taiwan, death by CVD has been third or fourth in the top ten causes of death for many years. Therefore, it is important to educate people to understand their risk of having CVD. In this report, we present a web-based approach to assess CVD risk factors. There are two phases in our study: first, a systematic review of the literature on medical evidence for CVD was performed by several physicians and experts in this field. Second, a webbased assessment system designed for patients to evaluate their own risk factors was constructed in consideration of the results from the first phase. The main contribution of our research is to integrate the internet and web technology for people to evaluate their own risk factors for cardiovascular disease. We collected the current best medical evidence from research on CVD risk factors. Using this information, web technology provides the flexibility of “any time and anywhere” for people to assess risk privately.