Objective This paper aims to construct the bone health management system of community residents and to promote its application in Shanghai.
Methods With the method of patient tracking management (PTM), the study objective was to reverse track from the clinical diagnosis of patients admitted to the department of orthopedics, hospital intervention of inpatients, follow-up management of discharged patients, to radiation screening of residents with high risk of osteoporosis in community, thus to prepare for the construction and application of community residents bone health management system in Shanghai.
Results The study team conducted health management MDT (Multidisciplinary Team) and bone health communication base. The former constructed the MDT which consisted of technicians from the department of orthopedics, emergency, bone relaxation, endocrine, rehabilitation, Chinese traditional medicine, nursing and nutrition and implement the bone health multidisciplinary join intervention to general residents with high-risk of fracture according to the selected standard for high risk of osteoporosis before constructing medical system and popular science system. The latter set up a bone health communication base in the community with join intervention of the MDT in communities, buildings and schools, and brought the bone health-related knowledge to public with medical, community, enterprise and media resources,making them accept the healthy lifestyle and disease prevention and control knowledge, so as to promote the bone health. The system could be evaluated finally.
Conclusion The resident bone health management system for Shanghai residents has been applied in the medical, population science system and achieved good results. Although the system has some limitations, the countermeasures have been put forward to improve the system for the relevant government departments to maximize its function.