Individual case management system for sleep breathing disorder diseases

Abstract

The invention provides an individual case management system for sleep breathing disorder diseases, which comprises an individual case manager terminal and a patient terminal, the individual case manager terminal comprises a data management module, a patient screening module, a patient management module and a system configuration module, and the patient terminal comprises an information exchange module and a health science popularization module. The invention provides an individual case management system for sleep breathing disorder diseases. The system is used for solving the problems that in the prior art, the cognition degree is insufficient, the diagnosis and treatment rate is low, the compliance is low, and a traditional medical mode cannot provide enough individual management and long-term follow-up visit.

Description

Technical Field

[0001] The present invention relates to the field of medical health information technology, and in particular to a case management system for sleep breathing disorders. Background Art

[0002] Patients with sleep breathing disorders often suffer from symptoms such as snoring, sleep apnea, and excessive daytime sleepiness. The disease may also cause multiple organ and system damage such as hypertension, coronary heart disease, cerebrovascular disease, diabetes, and even sudden death during sleep, bringing a heavy economic burden to patients and society.

[0003] Although the current situation of sleep-disordered breathing, which is highly harmful, has a high incidence rate and a low diagnosis and treatment rate, has attracted serious attention, the management of sleep-disordered breathing is not ideal. The main problems are as follows:

[0004] Patients generally lack knowledge of the disease and therefore do not actively seek medical help;

[0005] Due to lack of awareness, patients often delay or give up treatment, resulting in low diagnosis and treatment rates;

[0006] The low compliance with treatment is due to the complexity of treatment methods and lack of effective support and education;

[0007] The traditional medical model cannot provide adequate personalized management and long-term follow-up. Summary of the invention

[0008] The present invention provides a case management system for sleep breathing disorders, which is used to solve the problems existing in the prior art, such as insufficient awareness, low diagnosis and treatment rate, low compliance, and the inability of traditional medical models to provide sufficient personalized management and long-term follow-up.

[0009] The present invention provides a case management system for sleep breathing disorders, including a case manager end and a patient end;

[0010] The case manager terminal includes a data management module, a system configuration module, a patient screening module and a patient management module, wherein:

[0011] The data management module is used to acquire, integrate and store patient information, and perform multi-dimensional screening based on all patient information, the patient information including basic information, sleep monitoring data, diagnosis information, doctor's order information, electronic medical records, test results, nursing records and questionnaires and scales;

[0012] The system configuration module is used to configure questionnaires, scales, health education leaflets, follow-up time, re-examination reminders, case acceptance standards and case closing standards;

[0013] The patient screening module is used to screen patients to be admitted according to the admission criteria, and admit the patients to be admitted after confirming that the patients have no language communication barriers, no mental illnesses, and have given informed consent;

[0014] The patient management module is used to match a personalized management plan for the admitted patient, mark the admitted patient, give a closing suggestion when the admitted patient meets the case closing criteria, and close the case after the case closing suggestion passes the review. Matching a personalized management plan for the admitted patient includes:

[0015] Pushing the sleep monitoring data, the questionnaire, the scale, the health education leaflet to the patient according to the patient information and following up the patient according to the follow-up time;

[0016] The patient end includes an information exchange module and a health science popularization module, wherein:

[0017] The information exchange module is used to receive, fill in and feed back the questionnaire and the scale to the patient management module;

[0018] The health science module is used to receive and study the health education leaflets.

[0019] The above scheme provides richer and more accurate information support for medical decision-making through comprehensive data integration; improves the flexibility and efficiency of case management through flexible system configuration, so that case management can adapt to different patients and medical scenarios; can quickly identify patients who meet the admission criteria through the automated screening mechanism, reducing the workload and time of manual screening and improving the accuracy of screening; provides personalized management plans for patients with different conditions, meets the needs of different patients, improves the compliance of patients, and ensures the consistency and systematization of treatment and follow-up work for patients from admission to closure; enables patients to obtain health science knowledge more conveniently, strengthens patients' understanding of diseases, and thus improves the diagnosis and treatment rate of patients.

[0020] Optionally, the patient information is stored in a sleep disorder specialty database in the form of structured data.

[0021] In the above scheme, centralized and structured database management improves the efficiency of data retrieval, storage and analysis, which can be used for research on sleep breathing disorders and promote the development of sleep medicine.

[0022] Optionally, sources of the patient information include an in-hospital system and the patient management module, and the in-hospital system includes HIS, LIS, PACS, EMR and a mobile nursing system.

[0023] Optionally, the case acceptance criteria include case acceptance criteria for patients of different age groups.

[0024] Optionally, the admission criteria for patients of different age groups include:

[0025] For children, the case acceptance criteria are a sleep apnea index greater than 5 times / hour or an obstructive apnea index greater than 1 time / hour, and the sleep apnea index and the obstructive apnea index are obtained from the sleep monitoring data;

[0026] For adults, the criteria for accepting cases are:

[0027] The sleep apnea index is greater than or equal to 5 times / hour and less than 15 times / hour, and there are specific clinical manifestations; or

[0028] The sleep apnea index is greater than or equal to 15 times / hour.

[0029] Optionally, the case closing criteria include:

[0030] The patient has been missing for more than 3 months; or

[0031] The patient in question dies; or

[0032] The admitted patient refuses to be followed up; or

[0033] The patient in question discontinues treatment; or

[0034] The patients have been under management for 2 years and their sleep apnea index is less than 5 times / hour.

[0035] Optionally, the pushing of the sleep monitoring data, the questionnaire, the scale, the health education leaflet to the admitted patient according to the patient information and the following-up of the admitted patient according to the follow-up time includes:

[0036] On the day of receiving the case, we will push out the popular science of sleep apnea, the sleep monitoring data, the basic situation questionnaire, the reason for consultation questionnaire, the daily life and sleep habits questionnaire, the past situation questionnaire, the snoring cognition questionnaire, the Epworth Sleepiness Scale, the Snoring Rating Scale and the OSA Patient Self-Management Behavior Scale;

[0037] Pushing medication guidance for the prescribed medication in the medical order information;

[0038] Pushing guidance on hypertension and / or hyperglycemia and / or hyperlipidemia in response to the presence of hypertension and / or hyperglycemia and / or hyperlipidemia in the test data;

[0039] For cases of mouth breathing in the electronic medical records, oropharyngeal muscle rehabilitation training is promoted;

[0040] Matching a treatment management plan with the treatment plan in the electronic medical record, including:

[0041] For cases where ventilator therapy is included in the treatment plan, popular science information on ventilator therapy is provided;

[0042] For cases where oral appliance treatment is included in the treatment plan, push out the precautions for oral appliance treatment;

[0043] If there is intestinal microecological treatment in the treatment plan, push the precautions for intestinal microecological treatment;

[0044] If there is weight loss treatment in the treatment plan, push the weight loss treatment precautions;

[0045] If the treatment plan involves surgery, the precautions before surgery, the precautions on the first day after surgery, and the precautions on the day of discharge are pushed. The surgeries include nasal surgery, soft palate plane surgery, glossopharyngeal plane surgery, and mandibular plane surgery for adults, and tonsillectomy and adenoidectomy for children;

[0046] A treatment status questionnaire is pushed on the first day after treatment, and a follow-up is conducted according to the follow-up time after treatment. The follow-up includes pushing the follow-up reminder and the questionnaire, scale and precautions required at the follow-up time. The follow-up reminder is pushed in the form of a text message.

[0047] Optionally, marking the admitted patients includes marking the admitted patients as lost contact, dead, refused follow-up, and discontinued treatment.

[0048] Optionally, the case manager side also includes a quality evaluation module, which is used to count and monitor key indicators, including the number of cases admitted, the number of cases closed, the registration completeness rate, the retention rate, the loss of contact rate, the transfer rate, the interruption rate, the satisfaction rate and the rate of improvement in daytime sleepiness symptoms.

[0049] Optionally, the patient management module and the information exchange module are also used for online interaction between the case manager and the patient. BRIEF DESCRIPTION OF THE DRAWINGS

[0050] In order to more clearly illustrate the technical solutions in the embodiments of the present invention, the drawings required for use in the description of the embodiments will be briefly introduced below. Obviously, the drawings described below are only some embodiments of the present invention. For ordinary technicians in this field, other drawings can be obtained based on these drawings without paying creative work.

[0051] Figure 1A schematic structural diagram of a case management system for sleep breathing disorders provided by an embodiment of the present invention. DETAILED DESCRIPTION

[0052] In order to make the purpose, technical scheme and advantages of the present invention clearer, the present invention will be further described in detail below with reference to the accompanying drawings. Obviously, the described embodiments are only part of the embodiments of the present invention, rather than all the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0053] Figure 1 A case management system for sleep breathing disorders provided by an embodiment of the present invention is shown in detail, including a case manager side and a patient side. The case manager side includes a data management module, a system configuration module, a patient screening module and a patient management module, and the patient side includes an information exchange module and a health science popularization module.

[0054] The data management module is used to acquire, integrate and store patient information, and perform multi-dimensional screening based on all patient information.

[0055] In the above solution, comprehensive data integration is used to provide richer and more accurate information support for medical decision-making.

[0056] Specifically, patient information includes basic information, sleep monitoring data, diagnosis information, doctor's order information, electronic medical records, test results, nursing records, and questionnaires and scales.

[0057] Basic information includes the patient's name, gender, age, contact information, etc.

[0058] Sleep monitoring data includes the results of various sleep monitoring conducted by patients (such as polysomnography (PSG), home sleep monitoring (HSAT), etc.), involving sleep apnea index (AHI), obstructive apnea index (Obstructive Apnea Index, OAI), minimum blood oxygen saturation (SaO2), sleep structure analysis, etc., among which the obstructive apnea index is the average number of obstructive apnea events per hour during sleep every night.

[0059] Diagnostic information includes the diagnosis code, diagnosis description and diagnosis date of sleep disorders.

[0060] Physician order information includes prescribed medications (i.e., patient medication use).

[0061] Electronic medical records include the patient's medical history, family history, allergy history, past medical history, smoking and drinking history, clinical manifestations, treatment plans, etc., including:

[0062] The medical history includes the type of disease;

[0063] Treatment options include the treatment the patient received (e.g., CPAP therapy, oral appliances, surgery, etc.), treatment start and end dates, etc.

[0064] Test results include blood tests, imaging tests (such as blood routine, X-ray, CT, MRI, etc.) and lung function tests.

[0065] Nursing records include vital signs (such as heart rate, blood pressure, body temperature, blood oxygen saturation, etc.), nursing operations, drug reactions, changes in condition, complication records and high-risk screening scales for sleep apnea, etc., which help to understand the patient's condition changes and evaluate the treatment effect.

[0066] Questionnaires and scales are used to evaluate the patient's treatment status during case management, including:

[0067] The questionnaires include basic information questionnaire, reason for consultation questionnaire, daily life and sleep habits questionnaire, past condition questionnaire, symptom assessment questionnaire (including assessment of whether the patient has mouth breathing, dry mouth and throat, dizziness, headache, pain, etc.), sleep quality assessment questionnaire, psychological status assessment questionnaire, disease cognition questionnaire (including snoring cognition questionnaire), satisfaction questionnaire (including treatment satisfaction questionnaire and follow-up satisfaction questionnaire, etc.), treatment status questionnaire, ventilator wearing experience questionnaire, ventilator wearing time questionnaire and ventilator complication occurrence questionnaire, etc. Its purpose is to collect necessary information to help medical professionals assess the patient's health status and provide personalized treatment or management suggestions accordingly;

[0068] The scales include the Epworth Sleepiness Scale, sleep quality assessment scale (such as the Pittsburgh Sleep Quality Index PSQI), snoring grading scale, quality of life and mental health scale, and OSA patient self-management behavior scale, etc., whose purpose is to assess sleep conditions and self-management ability.

[0069] The multi-dimensional screening mechanism supports screening based on different patient characteristics, including age, gender, test indicators, diagnostic code, body mass index, neck circumference, chest circumference, waist circumference, hip circumference, sleep habits, smoking history, drinking history, past medical history, family history, Epworth Sleepiness Scale score, Stop-Bang Scale score, snoring grade, surgical method, ventilator treatment status, etc., including:

[0070] Inspection indicators belong to inspection and test results;

[0071] Body mass index, neck circumference, chest circumference, waist circumference, hip circumference, sleeping habits, and ventilator treatment were questionnaire and scale conditions;

[0072] The Stop-Bang scale score is a high-risk screening scale for sleep-disordered breathing in the nursing record.

[0073] In one example, patient information is stored in a sleep disorder database in the form of structured data. The sleep disorder database serves the following purposes:

[0074] Assist doctors in clinical decision making;

[0075] Support multidisciplinary doctors to jointly diagnose and treat patients;

[0076] By comparing the patient's information before and after treatment, the treatment effect can be evaluated and the treatment plan can be adjusted in time;

[0077] Follow up the patient's treatment progress and carry out targeted health education.

[0078] In the above scheme, centralized and structured database management improves the efficiency of data retrieval, storage and analysis, which can be used for research on sleep breathing disorders and promote the development of sleep medicine.

[0079] In one example, sources of patient information include in-hospital systems and patient management modules, where the in-hospital systems include HIS, LIS, PACS, EMR, and mobile nursing systems, where:

[0080] HIS is the hospital information system, including functions such as drugs, charges, doctor's orders, and admission registration. Basic information comes from HIS;

[0081] LIS is the laboratory information system, which includes functions such as generating test reports, and the blood tests in the test results are derived from LIS;

[0082] PACS is an image storage and transmission system, including image acquisition, storage and display functions. Sleep monitoring data, imaging examinations and lung function tests in laboratory examination results come from PACS;

[0083] EMR is an electronic medical record system, including functions such as medical record writing. Diagnosis information, doctor's order information and electronic medical records all come from EMR;

[0084] The mobile nursing system includes functions such as entering nursing records, temperature sheets and various risk assessment sheets. The nursing records come from the mobile nursing system.

[0085] The system configuration module is used to configure questionnaires, scales, health education leaflets, follow-up time, re-visit reminders, case acceptance standards and case closing standards.

[0086] The above solution improves the flexibility and efficiency of case management through flexible system configuration, so that case management can adapt to different patients and medical scenarios.

[0087] The health education leaflets include medication guidance, rehabilitation exercise methods, disease-related knowledge, popular science and treatment precautions, including:

[0088] The methods of rehabilitation exercise include oral muscle rehabilitation training;

[0089] Disease-related knowledge refers to disease overview, hazards, treatment methods, etc., including popular science on sleep apnea, guidance on hypertension, guidance on hyperglycemia, and guidance on hyperlipidemia;

[0090] Treatment tips and precautions include:

[0091] Popular science on ventilator therapy, including the use, precautions, and disinfection and maintenance of ventilators for patients receiving ventilator therapy;

[0092] Precautions for oral appliance treatment, including precautions for oral appliance patients to wear the appliance;

[0093] Precautions for intestinal microecological treatment;

[0094] Precautions before surgery, on the first day after surgery, and on the day of discharge, including key points of diet and exercise for patients undergoing surgery, and how to handle emergencies;

[0095] Precautions for weight loss therapy, including the key points of diet and exercise control for patients who are losing weight;

[0096] Precautions to take at different times after treatment. For example, for patients undergoing surgical treatment, precautions one day after treatment include wound management, and precautions one month after treatment include weight loss management.

[0097] In one example, the admission criteria include admission criteria for patients of different age groups.

[0098] Furthermore, the admission criteria for patients of different age groups include:

[0099] For children, the admission criteria are a sleep apnea index greater than 5 times / hour or an obstructive apnea index greater than 1 time / hour. The sleep apnea index and obstructive apnea index are obtained from sleep monitoring data;

[0100] For adults, the case acceptance criteria are:

[0101] Sleep apnea index greater than or equal to 5 times / hour and less than 15 times / hour, and certain clinical manifestations; or

[0102] The sleep apnea index is greater than or equal to 15 times / hour.

[0103] In one example, children are those aged 1-18 years old, and adults are those aged 18 years and above.

[0104] In one example, specific clinical manifestations include sleep snoring with apnea and daytime sleepiness.

[0105] In one example, the closure criteria include:

[0106] The patient has been missing for more than 3 months; or

[0107] The patient dies; or

[0108] The admitted patient refuses to be followed up; or

[0109] The patient discontinues treatment; or

[0110] The patients were managed for 2 years and their sleep apnea index was less than 5 times / hour.

[0111] The patient screening module is used to screen patients to be admitted according to the admission standards, and to admit the patients after confirming that they have no language communication barriers, no mental illness, and have given informed consent.

[0112] The above scheme can quickly identify patients who meet the admission criteria through an automated screening mechanism, reducing the workload and time of manual screening and improving the accuracy of screening.

[0113] It should be noted that for the screened patients to be admitted, the case manager needs to conduct a face-to-face interview with the patients and accept the cases after confirming that the patients have no language communication barriers, no mental illness and have given informed consent.

[0114] The patient management module is used to match personalized management plans for admitted patients, mark admitted patients, give closure suggestions when admitted patients meet the closure criteria, and close the case after the closure suggestions are reviewed.

[0115] Specifically, matching personalized management plans for admitted patients includes:

[0116] According to the patient information, sleep monitoring data, questionnaires, scales, health education leaflets are pushed to the admitted patients, and the admitted patients are followed up according to the follow-up time.

[0117] The above-mentioned plan provides personalized management plans for patients with different medical conditions, meets the needs of different patients, improves the compliance of patients, and ensures the consistency and systematization of treatment and follow-up work throughout the entire process from case admission to case closure.

[0118] In one example, pushing sleep monitoring data, questionnaires, scales, health education leaflets to admitted patients based on patient information and following up on admitted patients according to follow-up time include:

[0119] On the day of receiving the case, we will push out popular science information about sleep apnea, sleep monitoring data, basic situation questionnaire, reason for consultation questionnaire, daily life and sleep habits questionnaire, past situation questionnaire, snoring cognition questionnaire, Epworth Sleepiness Scale, Snoring Rating Scale and OSA Patient Self-Management Behavior Scale;

[0120] Push medication guidance for prescribed medications in doctor's order information;

[0121] Push guidance on hypertension and / or hyperglycemia and / or hyperlipidemia in case of hypertension and / or hyperglycemia and / or hyperlipidemia in the test data;

[0122] For cases of mouth breathing in the electronic medical records, oropharyngeal muscle rehabilitation training is promoted;

[0123] Match treatment management plans to treatment plans in electronic medical records, including:

[0124] For cases where ventilator therapy is included in the treatment plan, popular science information on ventilator therapy is provided;

[0125] For cases where oral appliance treatment is included in the treatment plan, push out the precautions for oral appliance treatment;

[0126] For cases where intestinal microecological treatment is included in the treatment plan, push out intestinal microecological treatment precautions;

[0127] If there is weight loss treatment in the treatment plan, push the weight loss treatment precautions;

[0128] If there is surgery in the treatment plan, we will provide information on precautions before surgery, precautions on the first day after surgery, and precautions on the day of discharge. The surgeries include nasal surgery, soft palate plane surgery, glossopharyngeal plane surgery, and mandibular plane surgery for adults, and tonsillectomy and adenoidectomy for children.

[0129] A treatment status questionnaire will be sent on the first day after treatment, and follow-up will be conducted according to the follow-up time after treatment. The follow-up includes sending follow-up reminders and the questionnaires, scales and precautions required during the follow-up time. The follow-up reminders will be sent in the form of text messages.

[0130] In one example, marking the admitted patients includes marking the admitted patients as lost contact, dead, refused follow-up, and discontinued treatment.

[0131] In one example, the patient management module is also used to view the patient's portrait tags, so that case managers can view the portrait tags while viewing the personalized management plan, which is more convenient than viewing in the data management module and facilitates the overall evaluation of the patient. The portrait tags include the patient's medical history, medication history, historical medical records and diagnosis, etc.

[0132] In one example, the patient management module is also used to view historical follow-up details to monitor the status and treatment effects of admitted patients, which is more convenient to operate than viewing in the data management module.

[0133] In one example, the patient management module is also used to group admitted patients according to age or disease type, etc., in order to optimize treatment and management. The groups include pediatric snoring group, pediatric snoring combined with allergic rhinitis group, pediatric snoring double tonsil resection group, pediatric snoring simple tonsil resection group, adult snoring simple weight loss group, adult snoring oral appliance treatment group, adult snoring ventilator treatment group, adult snoring nasal surgery group, adult snoring pharyngeal surgery group and adult snoring nasal postoperative ventilator group, etc.

[0134] In one example, the patient management module is also used to enter missing data in response to possible omissions when patients fill out questionnaires and scales.

[0135] In one example, the patient management module is also used for remote monitoring and feedback, including remote monitoring of the sleep status and ventilator usage of registered patients based on wearable devices, and adjusting treatment plans based on real-time data and providing feedback to the registered patients.

[0136] In the above scheme, remote data collection and patient status monitoring facilitate effective remote management of admitted patients.

[0137] The case manager end also includes a quality evaluation module, which is used to count and monitor key indicators, including the number of cases received, the number of cases under management, the number of cases closed, the case closing rate, the registration completeness rate, the retention rate and the loss of contact rate, the transfer rate, the interruption rate, the satisfaction rate and the daytime sleepiness symptom improvement rate, among which:

[0138] The case closing rate is the ratio of the number of closed cases to the number of accepted cases. The case closing rate can reflect the treatment effect of the accepted patients and the efficiency of case management.

[0139] The registration completeness rate is the ratio of the number of filled-in items to the number of mandatory items. In order to avoid affecting the patient's experience, the mandatory items of the questionnaire and scale can be submitted without filling in. Therefore, the registration completeness rate is needed to evaluate the completeness of data collection;

[0140] The retention rate is the ratio of the number of patients who chose to stay in the questionnaire to the number of patients admitted. In one example, the number of patients who chose to stay in the questionnaire was determined by the number of patients who chose to continue treatment in our hospital in the 3-month, 6-month, 12-month and 2-year follow-up questionnaires.

[0141] The missing rate is the ratio of the number of people marked as missing to the number of cases received;

[0142] The transfer rate is the ratio of the number of patients transferred to other hospitals for treatment to the total number of cases that should be followed up;

[0143] The discontinuation rate is the ratio of the number of patients who discontinued treatment to the total number of cases that should be followed up;

[0144] The satisfaction rate is the ratio of the number of cases that are satisfied and very satisfied with the treatment in that month to the total number of cases under management in that month;

[0145] The improvement rate of daytime sleepiness symptoms was the ratio of the total number of cases with an Epworth scale score of ≤10 after 6 months of management to the total number of cases with an Epworth scale score of ≥11 when the cases were admitted to the hospital in the same month.

[0146] The above scheme enables medical institutions to continuously evaluate and improve the quality of their services.

[0147] In one example, the case manager side also includes a multidisciplinary collaboration module, which is used to:

[0148] Allow multidisciplinary team members to access the complete medical records of admitted patients, including diagnosis information, treatment plans, medication history, and test results;

[0149] Provide real-time communication and video conferencing functions, so that multidisciplinary team members can communicate and discuss the treatment progress of admitted patients and adjust treatment plans at any time;

[0150] Provides meeting record function.

[0151] The information exchange module is used to fill in and feed back the received questionnaires and scales to the patient management module.

[0152] The health science module is used to study the received health education leaflets, which can be learned through videos or pictures and texts.

[0153] The above scheme enables patients to obtain health science knowledge more conveniently, strengthens their understanding of the disease, and thus improves the diagnosis and treatment rate of patients.

[0154] In one example, the patient terminal further includes a medical record query module and a medical appointment booking module, wherein:

[0155] The medical record query module is used to query the patient's own examination data, which comes from the data management module;

[0156] The medical appointment module is used to make appointments for outpatient clinics or hospitalizations. The medical appointment module can realize the function of making appointments for outpatient clinics or hospitalizations by connecting with the WeChat official account within the hospital.

[0157] The self-service in the above solution enables patients to more conveniently query medical records and make appointments for medical treatment, strengthens the self-management capabilities of patients, and increases their participation and satisfaction in health management.

[0158] In one example, the patient management module and the information exchange module are also used for online interaction between case managers and patients to achieve health consultation.

[0159] Although the preferred embodiments of the present invention have been described, those skilled in the art may make additional changes and modifications to these embodiments once they have learned the basic creative concept. Therefore, the appended claims are intended to be interpreted as including the preferred embodiments and all changes and modifications that fall within the scope of the present invention.

[0160] Obviously, those skilled in the art can make various changes and modifications to the present application without departing from the spirit and scope of the present application. Thus, if these modifications and variations of the present application fall within the scope of the claims of the present application and their equivalents, the present application is also intended to include these modifications and variations.

Claims

1. A case management system for sleep apnea, characterized in that: Includes case manager side and patient side; The case manager terminal includes a data management module, a system configuration module, a patient screening module and a patient management module, wherein: The data management module is used to acquire, integrate and store patient information, and perform multi-dimensional screening based on all patient information, the patient information including basic information, sleep monitoring data, diagnosis information, doctor's order information, electronic medical records, test results, nursing records and questionnaires and scales; The system configuration module is used to configure questionnaires, scales, health education leaflets, follow-up time, re-examination reminders, case acceptance standards and case closing standards; The patient screening module is used to screen patients to be admitted according to the admission criteria, and admit the patients to be admitted after confirming that the patients have no language communication barriers, no mental illnesses, and have given informed consent; The patient management module is used to match a personalized management plan for the admitted patient, mark the admitted patient, give a closing suggestion when the admitted patient meets the case closing criteria, and close the case after the case closing suggestion passes the review. Matching a personalized management plan for the admitted patient includes: Pushing the sleep monitoring data, the questionnaire, the scale, the health education leaflet to the patient according to the patient information and following up the patient according to the follow-up time; The patient end includes an information exchange module and a health science popularization module, wherein: The information exchange module is used to receive, fill in and feed back the questionnaire and the scale to the patient management module; The health science module is used to receive and study the health education leaflets.

2. The system according to claim 1, characterized in that: The patient information is stored in the sleep disorder database in the form of structured data.

3. The system according to claim 1, characterized in that: The sources of the patient information include the hospital system and the patient management module. The hospital system includes HIS, LIS, PACS, EMR and mobile nursing system.

4. The system according to claim 1, characterized in that: The case admission criteria include case admission criteria for patients of different age groups.

5. The system according to claim 4, characterized in that: The admission criteria for patients of different age groups include: For children, the case acceptance criteria are a sleep apnea index greater than 5 times / hour or an obstructive apnea index greater than 1 time / hour, and the sleep apnea index and the obstructive apnea index are obtained from the sleep monitoring data; For adults, the criteria for accepting cases are: The sleep apnea index is greater than or equal to 5 times / hour and less than 15 times / hour, and there are specific clinical manifestations; or The sleep apnea index is greater than or equal to 15 times / hour.

6. The system according to claim 1, characterized in that: The closure criteria include: The patient has been missing for more than 3 months; or The patient in question dies; or The admitted patient refuses to be followed up; or The patient in question discontinues treatment; or The patients have been under management for 2 years and their sleep apnea index is less than 5 times / hour.

7. The system according to claim 1, characterized in that: The step of pushing the sleep monitoring data, the questionnaire, the scale, and the health education leaflet to the patient according to the patient information and following up the patient according to the follow-up time includes: On the day of receiving the case, we will push out the popular science of sleep apnea, the sleep monitoring data, the basic situation questionnaire, the reason for consultation questionnaire, the daily life and sleep habits questionnaire, the past situation questionnaire, the snoring cognition questionnaire, the Epworth Sleepiness Scale, the Snoring Rating Scale and the OSA Patient Self-Management Behavior Scale; Pushing medication guidance for the prescribed medication in the medical order information; Pushing guidance on hypertension and / or hyperglycemia and / or hyperlipidemia in response to the presence of hypertension and / or hyperglycemia and / or hyperlipidemia in the test data; For cases of mouth breathing in the electronic medical records, oropharyngeal muscle rehabilitation training is promoted; Matching a treatment management plan with the treatment plan in the electronic medical record, including: For cases where ventilator therapy is included in the treatment plan, popular science information on ventilator therapy is provided; For cases where oral appliance treatment is included in the treatment plan, push out oral appliance treatment precautions; If there is intestinal microecological treatment in the treatment plan, push the precautions for intestinal microecological treatment; If there is weight loss treatment in the treatment plan, push the weight loss treatment precautions; If the treatment plan involves surgery, the precautions before surgery, the precautions on the first day after surgery, and the precautions on the day of discharge are pushed. The surgeries include nasal surgery, soft palate plane surgery, glossopharyngeal plane surgery, and mandibular plane surgery for adults, and tonsillectomy and adenoidectomy for children; A treatment status questionnaire is pushed on the first day after treatment, and a follow-up is conducted according to the follow-up time after treatment. The follow-up includes pushing the follow-up reminder and the questionnaire, scale and precautions required at the follow-up time. The follow-up reminder is pushed in the form of a text message.

8. The system according to claim 1, characterized in that: The marking of the admitted patients includes marking the admitted patients as lost contact, dead, refused follow-up, and discontinued treatment.

9. The system according to claim 1, characterized in that: The case manager side also includes a quality evaluation module, which is used to count and monitor key indicators, including the number of cases received, the number of cases closed, the registration completeness rate, the retention rate, the loss of contact rate, the transfer rate, the interruption rate, the satisfaction rate and the rate of improvement in daytime sleepiness symptoms.

10. The system according to claim 1, characterized in that: The patient management module and the information exchange module are also used for online interaction between the case manager and the patient.

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