X In 2010, the number of consultations at primary community healthcare institutions reached 60 million, 2.4 times the number of outpatient consultations for local residents at tertiary hospitals
X The proportion of patients who went to primary healthcare institutions has increased from 5% in 2006 to 42% at present, which is 10 times more than that of 2006
At 7:30 a.m., the third floor of the De Sheng Community Health Service Center in Beijing was full of patients waiting for consultations. patients. "You're number 15 in line, please sit outside and wait." The words of the triage nurse Cao Li surprised Li Qing, who lives in Xiaoshikou Hutong, Deshengmen. Li Qing exclaimed, "The community hospital used to be empty, but now how come there are queues to see the doctor?"
Since 2006, the Beijing Municipality through the reform of the community health system, the implementation of the two-line management of income and expenditure, zero-differential rate sales of medicines, the construction of general practitioners, improve the community health service capacity, and effectively reduce the outpatient pressure on large hospitals.
According to statistics, the number of grass-roots consultations in Beijing reached 60 million in 2010, 2.4 times the number of outpatient consultations for local residents in tertiary hospitals, and 10 times the number of people served at the grass-roots community level in 2006. The proportion of patients going to the grass-roots level increased from 5% in 2006 to 42% at present. The former "inverted pyramid" of "large hospitals are overcrowded, small communities are crowded" is being transformed into a "pyramid" structure.
Ding Xiangyang, deputy mayor of Beijing, pointed out that experience at home and abroad shows that the demand for medical services is a "pyramid" type, more than 80% of minor illnesses, chronic illnesses can be solved at the grass-roots level in the community health care institutions. Therefore, strengthening the capacity of primary community medical services, transferring the center of gravity of medical services from large hospitals to the grassroots community, and establishing a mechanism for the division of labor between public hospitals and primary health care institutions is an effective way to alleviate the "high cost of medical care and the difficulty of seeing a doctor".
Change in service model -
Family doctors: door to door to provide "point to point" health services
Na Kun is a general practitioner at the Fangzhuang Community Health Center. In the past, although he is familiar with many community residents, but specifically to which person has what disease, he is not very clear. Since the 67-year-old Chen Aili and he signed a "family doctor service agreement", he became "point to point" management of the elderly, regular home visits, tracking changes in the condition, provide health assessment, the implementation of fine management. Chen Aili said: "Which parts of my body have a problem, Dr. Na Kun knows it like the back of his hand, more than I know myself."
In Beijing's Dongcheng District, each family doctor is equipped with a "general practitioner laptop" for residents to establish a family health file, personal lifestyle files and electronic medical records, realizing the health of community residents to guide the whole process of health guidance, diagnosis and treatment, rehabilitation and other services. The workload of community health services has increased at an annual rate of 20%, the proportion of home visits by family doctors has increased from less than 4% before the reform to more than 20%, and the management rate of the four chronic diseases has increased from less than 30% before the reform to more than 80% now.
Each community family doctor team consists of three people: a general practitioner, a community nurse and a preventive health care worker. In terms of service mode, the family doctor team has changed the practice of "sitting and waiting for patients" in the past, and realized contractual health management by signing health management agreements, establishing a relatively stable voluntary service relationship, and providing residents with proactive and continuous health services, and the family doctor team and the community residents "are also doctors and friends". Family doctor teams and community residents are "doctors and friends". It is reported that by the end of 2012, every family living in Beijing will be able to voluntarily choose, sign a contract and have a 24-hour on-call community family doctor team free of charge.
Beijing Municipal Health Bureau Director Fang Laiying said, family doctor-style services adhere to the principle of voluntary contracting, free choice, standardized services, according to the ratio of 1:600, the service team and service families signed a service agreement, the contracted object focus on the elderly, women, children and chronic disease patients. Currently, nearly 400,000 residents in Beijing's three pilot districts and counties have signed up to have a family doctor with 24-hour service.
Changes in the medical model --
Family health care workers: guiding families to establish a healthy lifestyle
"To eat dumplings, eat eight first, and then four two hours later, for a total of no more than 12. Insist on small, frequent meals and eat six meals a day." Li Xuelan of Xicheng District, nearly seventy years old, talking about diabetic diet. In the past, she loved big oil and meat and had a heavy taste. Nowadays, every time she cooks, she can't do without two tools: a small salt spoon and a small oil cup, which are distributed free of charge by the municipal government.
Early in 2008, after rigorous training and assessment, Li Xuelan became one of the first 10,000 family health workers in Beijing, gradually mastering the diet and exercise rules for diabetics. She has a clear idea of how much she needs to eat a bun and how much she needs to walk in order to achieve energy balance. Li Xuelan said, now is the family's health are her strict "management" up, blood sugar, blood pressure, blood fat, weight and other indicators all normal.
The "Family Health Worker Program" refers to the selection of a member of the family, after self-study or training, to master practical knowledge and skills to prevent and treat chronic diseases, including coronary heart disease, hypertension, diabetes, stroke and so on. The family member is then provided with health education and guidance, leading the whole family to gradually establish a healthy lifestyle. The free training of family health workers for chronically ill families is equivalent to having a 24-hour "doctor" by the side of the chronically ill.
According to statistics, Beijing has trained 100,000 family health care workers for chronic disease families free of charge. By the end of 2015, the city's chronic disease family health care workers will reach 200,000 to help professionals take on the responsibility of chronic disease prevention and treatment at home and in the community, and initially form a comprehensive management model of chronic disease in the community.
In the Xicheng District Exhibition Road Community Health Service Center, there are many health monitoring equipment, such as cardiovascular detector, bone density, blood glucose detector, traditional Chinese medicine five organs phase sound identification detection system. Chang Shuling, director of the center, told reporters that the establishment of the residents' health detection system has improved the community's ability to manage chronic diseases and cultivated the residents' awareness of health self-management, which allows the residents to "not be sick, less sick, and get sick later".
Ding Xiangyang, vice mayor of Beijing, believes that with the changes in the disease spectrum, cardiovascular and cerebrovascular diseases, geriatric diseases, infectious diseases and other five major diseases have become the main factors affecting health. Therefore, it is necessary to take "prevention as the mainstay" as the preferred strategy for everyone to enjoy basic medical and health services, and shift the focus of health work from back-end treatment to front-end prevention.
Changes in diagnosis and treatment model -
Two-way referral: from competition to cooperation between hospitals and communities
Recently, Liu Xifu, an old man who lives in Beijing's Haiyuncang community, felt dizziness and numbness in his hands, and the old man's son called Dr. Ma Jia of the community health station. According to the patient's past medical history, considering the seriousness of the condition, Ma Jia immediately contacted the Dongzhimen Hospital of Traditional Chinese Medicine with counterpart support, and the patient was immediately transferred to the Dongzhimen Hospital through the two-way referral green channel, and was clearly identified as "lacunar cerebral infarction" through examination. Because of the timely diagnosis and treatment, the patient did not occur sequelae, the quality of life of the elderly has not been affected.
Liu Xifu said that if not for the establishment of a "green channel" between the community and the hospital, his life would have been lost.
Dr. Ma Jia said, the community and hospitals have different advantages, the establishment of the "green channel", the two sides from competition into collaboration, forming an organic whole, the people to see a doctor unhindered, save time and effort. Community doctors encounter diagnosis of unclear and unable to deal with the disease, you can always ask for advice and make an appointment with a specialist. When the patient arrives at the hospital, there are specialized nurses accompanying the whole process, and there is no need to register and wait. If a test is done, the patient doesn't need to make a special trip to get it, the hospital will send the results back to the community in a timely manner.
By the end of this year, Beijing will complete an interconnected network covering the city's community health service management centers, community health service centers and community health service stations, realizing the organic docking of large hospitals and community health service institutions, and the organic docking of large specialists and community doctors.
"In the appointment referral we carry out, *** there are 28 large hospitals and more than 200 community health service organizations to establish a referral relationship, only Xuanwu Hospital a last year accepted nearly 1,200 times of community referral patients, the referral rate is as high as 99.79%." Chen Jing, deputy director of the medical administration department of the Beijing Municipal Health Bureau, said.
In order to speed up the construction of community health service talents, Beijing launched the "four batch" project, namely "come in a batch, come out a batch, come back a batch, down a batch". "In a batch" refers to the signing of a contract, the settlement of household registration, for the national medical and health institutions and general higher medical schools, the introduction of community health services suitable for Beijing's needs of bachelor's degree or above graduates and intermediate level, the age of 45 years old or younger health professionals and technicians. The "coming out batch" refers to the free training of order-oriented medical students for rural areas, etc. The "coming back batch" refers to the free training of order-oriented medical students for rural areas. The "coming back batch" refers to the exploration of delayed retirement policies for personnel of community health service organizations. "Down a batch" refers to the second and third-tier hospital health technicians in the promotion of intermediate titles before the community health service organizations to carry out counterpart support, no less than 30 days per person per year; clinical departments above the intermediate title of medical personnel, each year, must be to the community health service agencies to provide a cumulative total of no less than 15 days of service.