The first is to standardize the establishment and management of community health service institutions.
1, improve the network of community health service institutions.
Comprehensive consideration of regional health and family planning resources, service radius, service population, urbanization, aging, population migration and other factors, formulate a scientific and reasonable plan for the establishment of community health service institutions, and gradually improve the community health service network according to the plan. In the process of urban new residential areas or old city reconstruction, community health service institutions should be planned and built synchronously according to relevant requirements, and joint construction with old-age care institutions in the region should be encouraged. In areas with dense floating population, community health service institutions should be appropriately added according to the number of service people and the service radius. For counties and county-level city governments with large population, community health service institutions should be established or the existing health resources should be reformed in structure and function to develop community health services. In the process of promoting rural community construction, rural community health service institutions should be improved simultaneously according to local conditions. In the process of urbanization, after village committees are changed into neighborhood committees, all localities can transform the original village clinics into community health service stations or cancel the village clinics according to the actual situation and relevant standards.
2. Give full play to the positive role of social forces in running hospitals.
The main body of urban community health service network is community health service center and community health service station. Grassroots medical and health institutions such as clinics, out-patient departments and clinics are an important part of the community health service network. All localities should actively create conditions and encourage social forces to set up primary medical and health institutions to meet the diverse health service needs of residents. Encourage all localities to actively explore ways to subsidize basic medical and health services provided by grassroots medical and health institutions organized by social forces through government purchase of services.
3. Standardize the registration of general practitioners.
Clinicians engaged in general practice (including Chinese medicine) in community health service institutions are registered as general practitioners if they have passed the standardized training of general practitioners or obtained the qualifications for senior technical positions in general practice; Through the transfer training and on-the-job training of general practitioners recognized by the provincial health and family planning administrative department and the administrative department of traditional Chinese medicine, their practice scope will be registered as general practice, and other professions of corresponding categories can be added at the same time. All localities should complete the registration change of existing qualified personnel before the end of June 20 ×××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××
4. Improve the community health service environment.
Community health service institutions should create a good medical environment for clients, standardize the layout of departments, define functional divisions, and ensure that the service environment and facilities are clean, comfortable and warm, reflecting humanistic care. Vaccination, child health care, health education and Chinese medicine service areas should highlight their characteristics and create a suitable service atmosphere; Registration, triage, pharmacy and other service areas encourage the implementation of open window services. Encourage the use of self-service registration, electronic calling, self-service printing test results, health self-test and other facilities and equipment to improve residents' medical experience. Standardize the use of community health service agency logos, unify the visual identification system of community health service agencies, and unify work clothes, nameplates, visiting bags, etc. , and all kinds of signs inside the organization must be clear and easy to distinguish. In order to protect patients' privacy, a doctor and a consulting room should be provided if possible. Improve the barrier-free facilities of institutions, create a smoke-free institutional environment, and completely ban smoking in community health service institutions.
Two, strengthen the capacity building of basic medical and public health services in the community.
1, improve the ability of community medical services
Community health service institutions should focus on strengthening the construction of general practice and Chinese medicine, and improve the diagnosis and treatment ability of common diseases, frequently-occurring diseases and chronic diseases. According to the needs of the masses, professional departments such as rehabilitation, stomatology, gynecology (women's health care), pediatrics (children's health care) and psychology can be developed. Considering the service demand, aging process, two-way referral demand and basic conditions of institutions, the scale of inpatient beds in community health service institutions should be planned in a city area as a unit, and the number of beds in each community health service institution should be set reasonably to improve the efficiency of bed use. Beds in community health service institutions are mainly based on nursing and rehabilitation, and hospice care and elderly care beds can be set up if conditions permit. Township hospitals are transformed into community health service centers, and their inpatient beds and internal departments can be retained or adjusted according to actual needs. According to the needs of graded diagnosis and treatment, the required drug varieties are equipped in accordance with relevant regulations and requirements to meet the drug demand of patients.
2. Strengthen the linkage with public hospitals.
Support community health service institutions to establish a fixed cooperative relationship with public hospitals, and explore and promote the construction of medical complexes. Cooperative hospitals should reserve a certain proportion of outpatient number sources for community health service institutions, open a green channel for referral, and give priority to referral of patients. Encourage doctors in public hospitals to practice more in community health service institutions, and improve the ability of community health service through sitting, teaching, rounds and other ways. Taking diseases such as hypertension, diabetes and tuberculosis as the breakthrough point, we will build a communication platform between general practitioners and specialists in public hospitals, strengthen division of labor and cooperation, and explore the system of first consultation and two-way referral in communities. Gradually establish a follow-up service system for discharged patients in public hospitals to provide continuous services for transferred patients. Promote the construction of telemedicine system and carry out telemedicine services such as remote consultation, medical imaging and ECG diagnosis. Make full use of public hospitals and other resources, develop centralized inspection, promote mutual recognition of inspection and inspection, and reduce repeated medical treatment.
3. Implement community public health services.
Make full use of residents' health records, health statistics, special surveys and other information, regularly carry out community health diagnosis, clarify the basic health problems of residents in the area, and formulate crowd health intervention plans. Implement national basic public health service projects and continuously expand the scope of benefits. Strictly implement various public health service specifications and technical specifications, provide relevant basic public health services for specific groups according to service processes, and improve residents' sense of acquisition. Strengthen the division of labor and cooperation between community health service institutions and professional public health institutions, rationally set up public health service posts, further integrate basic medical care and public health services, and promote the combination of prevention and treatment. While steadily increasing the number of public health services, we should pay attention to strengthening the monitoring and management of the quality of public health services and pay attention to the effect of health management.
4. Vigorously develop Chinese medicine services.
In basic medical care, public health service and rehabilitation of chronic diseases, we should make full use of the resources of traditional Chinese medicine and give full play to its advantages and functions. Conditional community health service center to set up a comprehensive service area of traditional Chinese medicine. Strengthen publicity and training on the rational use of Chinese patent medicines, and popularize appropriate techniques such as acupuncture, massage, cupping and fumigation in traditional Chinese medicine. Actively carry out the service of "preventing diseases" of traditional Chinese medicine, provide health consultation, health status appraisal and intervention services for community residents, and vigorously publicize and popularize the health concept and knowledge of traditional Chinese medicine.
5. Strengthen the construction of community health talents.
Rationally allocate the post structure of community health service institutions and strengthen the construction of community health talents with general practitioners and community nurses as the focus. Continue to increase support for the standardized training of general practitioners and actively take measures to encourage medical graduates to participate in the standardized training of general practitioners. Vigorously promote the transfer training of general practitioners and enrich the team of general practitioners. Focus on improving practical skills, strengthen the training of on-the-job community health personnel and continuing medical education, and community health technicians shall participate in technical training for not less than 3 months every 5 years. All localities should regularly carry out training for managers of community health service institutions, and cultivate a group of managers who understand business, can manage and are satisfied with the masses.
Third, change the service model and vigorously promote grassroots contract services.
1. Strengthen the construction of contracted doctors.
The team of contracted doctors consists of doctors from hospitals above the second level and medical staff from primary health care institutions. According to the service radius and population of the jurisdiction, the area of team responsibility is reasonably divided and grid management is implemented. The team of contracted doctors should master the main health problems of residents within their jurisdiction, carry out health education and health promotion, risk factor intervention and disease prevention, and realize comprehensive, sustained and effective health management services. By 20xx, we will strive to make every family have qualified contracted doctors and every resident have electronic health records.
2. Vigorously promote grassroots contracting services.
Promote the team of contracted doctors to sign service agreements with residents or families and establish contracted service relationships. At the initial stage of contracted service, we should focus on the elderly, patients with chronic diseases and severe mental disorders, pregnant women, children, the disabled and other people who have used community health services for a long time, and gradually expand to the general population. In the process of promoting contract service, we should pay attention to the effect of contract service, make clear the content and conditions of contract service, determine the responsibilities, rights and obligations of both parties, strive to make residents obtain more convenient medical and health services through contract service, and guide residents to actively sign contracts. Explore the provision of differentiated services, classified contracting, paid contracting and other forms of contracting services to meet the multi-level service needs of residents. Improve the incentive and restraint mechanism of contract service, and the contract service fee is mainly solved by medical insurance fund, contract residents' payment and basic public health service funds.
3. Carry out convenience services
Community health service institutions should arrange medical treatment time reasonably. Conditional community health service institutions should appropriately extend the time of medical treatment and open outpatient service on weekends and holidays, and implement wrong time service to meet the medical needs of working people. Encourage all localities to focus on the management of patients with chronic diseases, vaccination, child health care, maternal health care and other related clients, and gradually carry out appointment diagnosis and treatment services in different periods. Regular follow-up of key populations and visits to patients in need. Vigorously develop community nursing and encourage home nursing service.
4. Do a good job in community health services for floating population.
All localities should bring migrant workers and their families into the service scope of community health service institutions, rationally allocate health technicians according to the actual service population, and facilitate the floating population to obtain medical and health services nearby. According to the relevant regulations, the floating population enjoys the same free basic public health services as the registered population at their place of residence. It is necessary to go deep into the areas where the floating population is concentrated, and publicize them through various forms such as preaching, posting posters, distributing materials and new media, so that they can understand the service targets, contents and processes of the national basic public health service projects. According to the characteristics of floating population, we will focus on strengthening public health services such as health education, prevention and control of infectious diseases, vaccination and maternal health care.
5. Expand the function of community health service.
According to the basic medical and health needs of the community, we will constantly improve the content of community health services, enrich service forms and expand service items. Encourage community health service institutions and pension service institutions to carry out various forms of cooperation, strengthen cooperation with relevant departments, and jointly promote the service model of combining medical care with nursing care. Encourage community health service institutions to carry out targeted basic medical and health services for government agencies, schools, office buildings and other functional community groups in the service area. Guide community residents to participate in community health services, and constantly improve residents' awareness of self-health management by developing clubs or mutual aid groups for patients with chronic diseases and training family health workers.
Four, strengthen the community health service guarantee and supervision and management.
1, strengthen medical quality and safety.
Strictly implement the relevant laws, regulations, rules and diagnostic norms of medical quality management, and strengthen medical quality control. Strengthen the certification and verification of disposable medical supplies, disinfectants and disinfection instruments. Medical equipment and environment in key departments such as stomatology, disinfection supply room, treatment room, dressing changing room and debridement room should be strictly cleaned, disinfected and sterilized. Strengthen hospital infection control, strictly implement disinfection and sterilization operation specifications, dispose of medical waste as required, and implement registration management system to ensure medical safety. Strictly abide by the use principles of antibacterial drugs and hormones and the indications for the combined use of antibacterial drugs. Reasonable choice of route of administration, strict control of the proportion of antibacterial drugs, hormones and intravenous drugs, to ensure that the medication is consistent with the diagnosis. Improve the medical risk sharing mechanism and encourage community health service institutions to participate in medical liability insurance.
2. Strengthen information technology support.
Promote the "one card" for residents to seek medical treatment and make good use of electronic health records. Taking the community as a unit, we will co-ordinate the construction of the information management system of community health service institutions, and further integrate various related business systems such as maternal and child health care, family planning, vaccination, infectious disease reporting, and severe mental disorders to avoid repeated data entry. Promote the effective docking between the community health information platform and the comprehensive information platform of community public services, and promote the organic integration and system integration of community health services with other community public services, convenience and benefit services and voluntary mutual assistance services. Constantly improve the functions of community health service information management system, gradually realize the application functions of appointment, registration, diagnosis and treatment, referral, public health service, charging, medical insurance settlement, inspection and drug management, strengthen the integration and sharing of information within the organization, and gradually realize the dynamic supervision of service quantity and quality through the information system. Strengthen the construction of regional health information platform, and promote the information interconnection and resource sharing between community health service institutions and other medical and health institutions in the region. Make full use of modern information technologies such as mobile Internet, smart client and instant messaging to strengthen doctor-patient interaction, improve residents' feelings and improve service efficiency.
3. Strengthen policy support and performance appraisal.
Health and family planning administrative departments at all levels and traditional Chinese medicine administrative departments should promote the implementation of community health service institutions, financial subsidies, personnel allocation and other related security policies, and fully mobilize the enthusiasm of community medical personnel. Further strengthen the supervision and management of community health service institutions, establish and improve various management systems, and strengthen the construction of culture and medical ethics in community health service institutions. All localities should constantly improve the performance appraisal system, incorporate the relevant contents of improving service quality into the key contents of the assessment of community health service institutions, promote the continuous improvement of community health service institutions, and improve the trust and utilization rate of residents.