Volume 24 Issue 3
Mar.  2026
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Article Navigation >  Chinese Journal of General Practice  > 2026  >  24(3): 437-441
YING Jiapei, HUANG Dandan, CHEN Lingling, YAO Yao, GAN Rong, DAI Lili. Investigation into the use of an intelligent follow-up management system for enhancing self-management skills in patients with chronic kidney disease[J]. Chinese Journal of General Practice, 2026, 24(3): 437-441. doi: 10.16766/j.cnki.issn.1674-4152.004414
Citation: YING Jiapei, HUANG Dandan, CHEN Lingling, YAO Yao, GAN Rong, DAI Lili. Investigation into the use of an intelligent follow-up management system for enhancing self-management skills in patients with chronic kidney disease[J]. Chinese Journal of General Practice, 2026, 24(3): 437-441. doi: 10.16766/j.cnki.issn.1674-4152.004414
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Investigation into the use of an intelligent follow-up management system for enhancing self-management skills in patients with chronic kidney disease

doi: 10.16766/j.cnki.issn.1674-4152.004414

  • Department of Nephrology, the First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China

Funds:

 2025HY0924

 2023KY254

 H2022YJ004

  • Received Date: 2025-03-11
    Available Online: 2026-06-02
    Abstract
  •   Objective  The intelligent follow-up management system was applied in patients with CKD to evaluate its effects on self-management ability.  Methods  From April 2022 to March 2023, 207 patients with CKD recruited from a tertiary hospital in Zhejiang Province were randomly allocated into an intervention group (n=103) and a control group (n=104). The control group was followed up regularly, while the intervention group adopted intelligent follow-up management. Self-management ability, physiological indicators, standardized follow-up rate, and unplanned hospitalization rate were compared between the two groups before the intervention, 6 months post-intervention, and 12 months post-intervention.  Results  At 6 months and 12 months post-intervention, the intervention group's total self-management ability scores were (82.49±6.58) points and (89.07±5.29) points, respectively, which were significantly higher than those of the control group (77.25±10.56) points and (78.41±9.24)points, with statistically significant differences (P < 0.001); health indicators of the intervention group, including the estimated glomerular filtration rate difference (ΔeGFR), BMI compliance rate, diastolic blood pressure and systolic blood pressure were superior to those of the control group, with statistically significant differences (P < 0.05). After the intervention, the intervention group achieved a significantly higher standardized follow-up rate [86.80% (80.00%, 100.00%)] compared to the control group [71.15% (50.00%, 100.00%), Z=5.241, P < 0.001]; clinically meaningful reductions in unplanned hospitalization rate were achieved in the intervention group 15.5% (15/97), substantially below control levels 28.0% (28/100), with statistical confirmation (χ2=4.535, P=0.033).  Conclusion  The intelligent follow-up management system can significantly enhance self-management proficiency in patients with CKD, improve health indicators.

     

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