Model essay on diabetes management work plan (3 selected articles)

Time flies so fast that people are caught off guard. We will start a new job soon. Let's learn to write a work plan together. But what should the work plan write? The following is a sample work plan for diabetes management compiled by me for reference only. Welcome to reading.

Diabetes Management Work Plan 1 I. Work Objectives

1. The filing rate of major chronic non-communicable diseases such as hypertension and diabetes is 99% in cities and 99% in rural areas; The health check-up rate of major chronic non-communicable diseases such as hypertension and diabetes has reached over 95%; The management rate of major chronic non-communicable diseases such as hypertension and diabetes has reached over 60%, the standardized management rate has reached over 85%, and the health check-up rate of patients with hypertension and diabetes has reached over 95%.

Second, the main task

Management of patients with hypertension

According to the management service standard of hypertension patients, standardize the management of hypertension patients aged 35 and above in the jurisdiction.

1. The screening method for patients with hypertension is: measure the blood pressure of residents aged 35 and above for the first time every year; Blood pressure was measured during the diagnosis and treatment of residents; Measure blood pressure in health examination and screening of high-risk groups; Let patients take the initiative to contact urban and rural primary medical and health institutions through publicity and education; Inquiries in the process of establishing residents' health records.

2. Establish health records of patients with hypertension. Establish health records of patients with hypertension, carry out physical examination, consultation, follow-up and health intervention for patients with hypertension as required, and record relevant information and activities in residents' health records for registration, so as to realize standardized management of the records. Strengthen the standardized management of registration of hypertensive patients in urban and rural primary health care institutions, realize the institutionalization of workflow and standardization of registration materials, and meet the requirements of national hypertension registration norms. Under the guidance of the Center for Disease Control and Prevention, institutions undertaking basic public health services should evaluate the quality of hypertension registration data in their respective jurisdictions and report them to the Center for Disease Control and Prevention. In the process of health management of patients with hypertension, we should make good use of active health records and constantly enrich and enrich the contents of health records.

3. Management of patients with hypertension. Primary medical and health institutions in urban and rural areas should provide at least 4 face-to-face follow-up visits to patients with hypertension diagnosed every year. Every time you follow up, you should ask about your illness, make blood pressure measurement and other inspections and evaluations, and give health guidance such as medication, diet, exercise and psychology.

4. Health examination of patients with hypertension. Patients with hypertension should have a health examination at least once a year, and free health examination services can be provided in combination with follow-up, including general physical examination, urine analysis, blood routine, blood sugar (random blood sugar, fasting blood sugar), blood lipid (total cholesterol, triglyceride), electrocardiogram, liver function, B-ultrasound, chest X-ray (examination of liver, gallbladder, pancreas, spleen and kidney).

(2) Management of patients with type 2 diabetes

According to the Management Service Standard for Patients with Type 2 Diabetes, standardize the management of patients with type 2 diabetes aged 18 years and above in the jurisdiction.

1, patients with type 2 diabetes were found. The ways to find out are: health examination and screening of high-risk groups to detect blood sugar; It is suggested that high-risk groups should measure blood sugar at least once a year; Let patients take the initiative to contact urban and rural primary medical and health institutions through publicity and education; Ask in the process of establishing health records for residents in the jurisdiction.

2. Registration of patients with type 2 diabetes and establishment of health records. Establish health records of patients with type 2 diabetes, carry out physical examination, consultation, follow-up and health intervention for patients with type 2 diabetes as required, and record relevant information and activities in residents' health records for registration, so as to realize standardized management of files. Basic medical and health institutions in urban and rural areas should provide at least 4 face-to-face follow-up visits every year. Each follow-up visit should ask about the condition, check and evaluate fasting blood sugar and blood pressure measurement, and carry out health guidance such as medication, diet, exercise and psychology. Banner Center for Disease Control and Prevention guides the institutions undertaking basic public health services to evaluate the quality of registration data of type 2 diabetes mellitus within their jurisdiction and report it to the Center for Disease Control and Prevention. In the process of health management for patients with type 2 diabetes, we should make good use of active health records and constantly enrich and enrich the contents of health records.

3. Health check. Patients with type 2 diabetes receive health examination at least four times a year, which can be combined with follow-up, and provide free health examination services, including general physical examination, urine analysis, blood routine, blood sugar (random blood sugar, fasting blood sugar), blood lipid (total cholesterol, triglyceride), electrocardiogram, liver function, B-ultrasound, chest X-ray (examination of liver, gallbladder, pancreas, spleen and kidney).

4. Strengthen the standardized construction of registration rooms in primary medical and health institutions in urban and rural areas, institutionalize the workflow, realize the standardized management of registration materials, and meet the requirements of national diabetes registration standards.

Work plan for diabetes management 2 I. Work objectives

1. Establish a basic information system for chronic diseases, register and file newly diagnosed diabetes cases by using the existing network, and formulate a chronic disease management system. The leadership is responsible for this work, and the responsibility is implemented to people.

2. By using residents' health records and organizing residents' health check-ups, early detection of diabetic patients can improve the early diagnosis rate and early treatment rate of diabetes.

3. Strengthen the follow-up management of patients with primary diabetes, improve the standardized management rate and control rate of diabetes, improve the self-management and knowledge and skills of diabetic patients, and reduce or delay the occurrence of diabetic complications.

4. With our hospital as the core, village clinics as the foundation, focusing on prevention and treatment by groups and individual prevention and control, explore the management mode and mechanism of establishing county CDC, evaluating our hospital's assistance in diagnosis, individualized treatment, providing technical support and follow-up management of diabetes in village clinics.

5, strengthen health education and health promotion, regularly carry out diabetes lectures and public propaganda, popularize knowledge of diabetes prevention and treatment among grassroots residents, control various risk factors, and improve people's health awareness.

6. Establish a standardized diabetes file management system.

Second, the filing work objectives

1. Establish health records of grassroots residents, and the baseline survey rate of grassroots service population reaches over 90%;

2. Establish health records, follow-up records, treatment records and health education records of diabetic patients.

Third, the implementation plan

Establish a working system for chronic diseases; To carry out the prevention and treatment of diabetes in the general population at the grass-roots level and establish a comprehensive prevention and treatment mechanism for diabetes at the grass-roots level.

1, detecting diabetes

Through the establishment of health records of grassroots residents, physical examination, diagnosis and treatment in grassroots hospitals, free blood pressure measurement and blood sugar measurement at grassroots level, active detection and first blood pressure measurement, diabetic patients were found.

2. Registration of diabetic patients

Register, file and standardize the detected patients with hypertension and diabetes.

3. Follow-up management and referral of diabetic patients.

For the detected diabetic patients, according to the clinical situation and comprehensive treatment plan, judge the management category that patients need to follow up and manage, and fill in the management card for patients with primary diabetes. Medication and non-medication for diabetic patients. When the patient has a condition that meets the referral situation, he will be referred to the superior general hospital in time, and then transferred back to the village clinic (station) for further treatment and follow-up after the condition is stable. Help diabetics make self-management plans and provide self-management support for diabetics.

Health guidance and intervention for people at high risk of diabetes;

1. Definition and detection of high-risk population of diabetes.

According to the definition standard of high-risk group of diabetes, the high-risk group of diabetes was found through daily diagnosis and treatment, health examination, establishment of health files and active screening.

2. Health guidance and intervention for people at high risk of diabetes.

Take the method of combining group and individual health guidance for high-risk groups, carry out health education to change unhealthy lifestyles, improve the understanding of diabetes and risk factors for high-risk groups through health education, give guidance on healthy lifestyles, and measure blood pressure and blood sugar regularly.

Promote the health of ordinary people at the grassroots level;

According to the health needs of the grassroots, we should widely publicize the knowledge of diabetes prevention and treatment at the grassroots level, advocate a healthy lifestyle, encourage the grassroots to change their unhealthy lifestyles, reduce risk factors, and prevent and reduce the occurrence of diabetes.

1. Establish a publicity window for diabetes prevention knowledge in our hospital and village clinics, publish relevant contents at least four times a year, make a leaflet on diabetes prevention knowledge, and distribute it to grassroots people through village committees and medical stations.

2. Do a good job in chronic disease publicity day: take chronic disease-related publicity as the main line, through World Hypertension Day (May 17), World No Tobacco Day (May 3 1), National Hypertension Day (June 65438+1October 8) and United Nations Diabetes Day (June 65438).

3, in the area of villages to carry out free blood sugar testing activities.

Fourth, training.

According to the "Guidelines for the Prevention and Treatment of Diabetes in China", rural doctors in village clinics were trained, and the training times were increased when necessary to improve the quality of diabetes management.

Verb (abbreviation of verb) evaluation

1, process evaluation

Dynamic management of diabetes filing, development of diabetes follow-up management, implementation of two-way referral, patient satisfaction, etc.

2. Effect evaluation

The awareness rate of diabetes prevention knowledge, the change rate of diabetes-related risk behaviors, the control of blood pressure and blood sugar, and the standardized treatment of diabetes.

Supervision and evaluation of intransitive verbs

1, our hospital is responsible for the supervision and assessment of village clinics within its jurisdiction, and the assessment opinions are fed back to the inspected units in time so as to improve the work in time.

2, the village clinic to develop internal working system, workflow and quality control rules and regulations, strengthen self-inspection.

Diabetes Management Work Plan 3 With the development of economy, the change of lifestyle and the acceleration of social aging, the incidence and prevalence of chronic diseases such as diabetes, coronary heart disease and malignant tumor are on the rise rapidly, and the disability rate and mortality rate are high, which seriously affects the physical and mental health of patients and brings heavy burdens to individuals, families and society. Therefore, the prevention and treatment of chronic diseases is particularly important, and the focus of chronic disease prevention and treatment is in the community. The quality of community chronic disease prevention and control is directly related to the effect of chronic disease prevention and control. Our hospital fully understands the importance of prevention and treatment of chronic diseases, and takes the road of "combining prevention with treatment, giving priority to prevention" in combination with the basic public health service standards in Shandong Province. This year's diabetes prevention and control work plan is specially formulated.

I. Work objectives

1. Through the implementation of the basic public health service diabetes management project in Shandong Province, we will implement intervention measures for chronic diseases such as diabetes and related risk factors in urban and rural residents, reduce unhealthy lifestyles such as high-sugar diet and obesity, reduce the harm of major health risk factors to human bodies, and effectively prevent and control the occurrence of diabetes.

2. Follow-up of diabetes diagnosed clearly, and the registration rate of new diabetes is100%; The health check-up rate of diagnosed diabetes is over 98%; The standardized management rate of diabetes with definite diagnosis reached 60%; Above all, the blood sugar control rate of the main chronic non-communicable disease of diabetes diagnosed clearly is above 35%.

Second, the main measures

1. According to the basic public health service standards of Shandong Province, standardize the management of type 2 diabetes patients aged 18 years and above within the jurisdiction.

2. Found patients with type 2 diabetes. The ways to find out are: health examination and screening of high-risk groups to detect blood sugar; It is suggested that high-risk groups should measure blood sugar at least once a year; Through health education, let patients take the initiative to understand diabetes and do a good job in diabetes prevention and treatment.

3. Registration of patients with type 2 diabetes and establishment of health records. Establish health records of patients with type 2 diabetes, carry out physical examination, consultation, follow-up and health intervention for patients with type 2 diabetes as required, and record relevant information and activities in residents' health records for registration, so as to realize standardized management of files. Street and village medical and health institutions should provide at least 4 face-to-face follow-up visits every year. Every follow-up should ask about the condition, check and evaluate the measurement of fasting blood sugar and blood pressure, and give health guidance such as medication, diet, exercise and psychology.

4. Health check. Community 4 145 patients with type 2 diabetes should have 1 time comprehensive health examination every year, which can be combined with follow-up. The contents include: determination of blood pressure, weight, fasting blood glucose (blood), general physical examination and general examination of vision, hearing and activity ability. Older people over 65 years old should increase blood routine, urine routine, blood lipid, electrocardiogram, liver function and cognitive function.

5, strengthen health education and health promotion, regularly carry out lectures and publicity on hypertension, popularize knowledge of hypertension prevention and treatment among community residents, control various risk factors, and improve people's health awareness.

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