Recently, the National Health Commission and other departments issued the "Quality Service at Grassroots Level" Activity and the Three Year Action Plan for Community Hospital Construction ", which proposed that by 2025, township health centers and community health service centers serving more than 10000 people will generally meet the capacity standards.
It is an important part of building a high-quality and efficient medical and health service system to improve the ability of basic level medical services and allow people to access more equitable and continuous medical and health services nearby. In the county medical and health service system, township hospitals are the connecting link between the preceding and the following hubs, and assume the important function of maintaining the health of grassroots people. Recently, the reporter went to township hospitals in Hunan, Chongqing, Sichuan and other places to visit how to improve grass-roots medical service capacity.
Concentrate on cultivating and building a number of grass-roots clinical characteristic departments in township hospitals, and significantly improve the medical service ability
He straightened his hands, raised them upward, and pushed his head upward. As he leaned forward, Liu Peide took a deep breath. Early in the morning, he practiced breathing exercises in the corridor of the town hospital. Liu Peide, 76 years old, lives in Guangping Village, Huangxu Town, Jingyang District, Deyang City, Sichuan Province. Recently, he had a high fever and was sent to the Huangxu Town Health Center.
"My chronic obstructive pulmonary disease (COPD) is an old problem, which is easy to recur in winter." Liu Peide said while practicing, "Fortunately, the town hospital has set up a respiratory department, with specialist doctors to diagnose and treat it, and the doctors also taught me breathing exercises. If I have a disease, I can see it at home, so I don't have to travel more than ten kilometers to the big hospital in the city."
In 2020, through the specialist alliance, Deyang Jingyang District Hospital of Traditional Chinese Medicine will help Huangxu Town Hospital to jointly build a respiratory department. Experts from the hospital will regularly sit in for diagnosis, teach and make rounds. The hospital will open beds and train medical staff. As the director of the Department of Respiratory Medicine of Jingyang District Hospital of Traditional Chinese Medicine, Shi Chongyou will visit Huangxu Town Hospital once a week to diagnose and treat respiratory diseases for the local people.
In order to improve professional ability, Huangxu Town Health Center increased investment, improved department equipment and technical projects, and equipped with complete ventilators, pulmonary function meters, ECG monitors, etc. In combination with the needs of local people, the hospital also carried out new projects such as lung function testing, non-invasive ventilator assisted ventilation, electronic bronchoscopy and endoscopic treatment. Since the establishment of the Respiratory Department, about 90000 people have been diagnosed and treated.
"Township health centers are mainly responsible for the diagnosis and treatment of common and frequently occurring diseases, and the focus is to improve the medical service ability." Wang Jun, director of the Health Policy Research and Evaluation Center of Renmin University of China, said.
In recent years, various regions have concentrated on cultivating and building a number of grass-roots clinical characteristic departments in township hospitals through specialized alliance cooperation, clinical teaching, project cooperation and other ways, and the medical service capacity has been significantly improved. In Yichang City, Hubei Province, some township hospitals have hemodialysis rooms; In Mianzhu City, Sichuan Province, some town hospitals have set up special stomatological specialties
According to the person in charge of Wengjiang Township Health Center in Pingjiang County, Hunan Province, the township health center has medical equipment such as color ultrasound, full-automatic biochemical analyzer, and is also equipped with pre hospital and in-hospital emergency equipment, including defibrillators, ECG monitors, and cardiopulmonary resuscitation devices. The improvement of hardware equipment has greatly improved the basic diagnosis and treatment ability and emergency rescue ability of the hospital.
Continuously improve the internal refined management level of the medical community and attract outstanding talents to stay at the grassroots level
Grandma Cheng, 69, fell down at home and suffered painful swelling in her right wrist. She came to the Shiyan Health Center in Changshou District, Chongqing. Liao Xiaoyong, a doctor of Orthopaedics and Traumatology Department of Changshou District Hospital of Traditional Chinese Medicine, visited Shiyan Town Health Center. After his diagnosis, he found that Grandma Cheng had a fracture of the distal right radius, and soon carried out the corresponding reduction and fixation.
Liao Xiaoyong, a "county employed township doctor", was dispatched to Shiyan Town Health Center last August to carry out work and has served in the hospital for more than half a year. "Thanks to Dr. Liao, now the fracture can be solved in the villages and towns, and there is no need to queue up in the hospital in the urban area for treatment." Grandma Cheng said.
In view of the difficulties faced by the grass-roots medical and health institutions in recruiting and retaining people, Chongqing has sent doctors to work in township hospitals through the reform of the mechanism of "county employment for township use" and "township employment for village use", and guaranteed the economic treatment and working funds of the dispatched doctors to encourage and guide the flow of medical and health talents to the grass-roots.
"Since August 2022, Changshou District has sent two batches of 63 doctors from district level hospitals to primary medical and health institutions, including some professionals in obstetrics and gynecology, pediatrics, stomatology and other areas in short supply." Lin Lu, head of the Organization and Personnel Section of Changshou District Health Commission, said. Up to now, the dispatched talents have served more than 21600 people at the grassroots level, driving the total number of diagnoses and treatments at the grassroots medical and health institutions to increase by 24% year on year. The masses can enjoy expert services without leaving the streets or communities.
"County employment for township use" not only brings talent support to grassroots medical and health institutions, but also helps grassroots promote new technologies and new projects. "We have sent doctors below as the link to carry out more than 120 academic lectures and technical training in grass-roots medical and health institutions, taught more than 90 grass-roots talents, sent more than 60 people for further study, improved more than 90 system operation processes, promoted more than 40 new technologies and projects, and greatly improved the technical level of grass-roots medical and health institutions." Lin Lu said.
"To improve the ability of grass-roots medical services, we must release the vitality of grass-roots medical and health institutions." Wang Jun said that we should innovate the talent management model, promote the reform of personnel compensation, continue to improve the internal refined management level of the medical community, attract outstanding talents to stay at the grass-roots level, and make them truly become local health gatekeepers.
In Pingjiang County, Hunan Province, the medical community of the local General Hospital of Integrated Traditional Chinese and Western Medicine, through the division of responsibility by the vice president, provides targeted assistance to township health centers from hospital management, medical business, basic public health and other aspects in the form of department assistance, and injects "live water" into the development of grass-roots health.
"The experts from the General Hospital helped us to establish a sound management and operation system, standardize the responsibilities of departments, clarify the quality objectives of departments, standardize medical behavior, and improve the management of township hospitals." The relevant person in charge of Wengjiang Township Health Center said that in recent years, the public's sense of medical access has been growing.
Establish a scientific and reasonable referral mechanism to form a medical pattern of "minor illness at the grass-roots level, serious illness to the hospital, and recovery to the community"
Not long ago, Mr. Deng, a villager in Anding Town, Pingjiang County, Hunan Province, felt sudden chest pain and came to the town health center for ECG examination. After the examination, the doctor immediately uploaded the data to the county ECG platform. The doctor on duty confirmed that the patient was suffering from acute anterior wall myocardial infarction, called the emergency number quickly, told the emergency department and chest pain center to be ready, and instructed the doctors in the health center to rescue before the ambulance arrived. Within 20 minutes, the emergency station will transfer the patient to the First People's Hospital of Pingjiang County for surgery.
In recent years, all regions have realized information sharing among medical institutions by means of informatization, further improved the efficiency of referral, and let more high-quality resources sink to the grass-roots level. For example, Pingjiang County has established medical imaging center, ECG center and ultrasonic diagnosis center to form mutual recognition and sharing of information in medical diagnosis county.
"In the past, 24 township hospitals in the county were generally short of professionals in ECG, imaging, testing, etc. Most of them had DR (digital X-ray) equipment, ECG machines, but often there were no special technicians and diagnostic doctors." Wu Shiqi, director of the medical reform office of Pingjiang County Health Bureau, told reporters that the township hospitals could not do the original inspection and detection projects, Now, staff come to take samples every day, and doctors in county hospitals issue reports for free through the platform, which has realized medical technology services for township inspection, county diagnosis, and regional sharing.
"Through the information sharing platform, some patients stayed in township hospitals for diagnosis and treatment, and some patients went to county hospitals for treatment, avoiding repeated examinations, which not only saved labor costs, reduced missed diagnosis, but also won time for rescuing critical and severe patients." The relevant person in charge of the Pingjiang County Health Bureau in Hunan Province said that by 2023, the county's grassroots medical treatment rate will reach 76.26%, The number of inpatients in the county accounted for 86.78%, and the hierarchical diagnosis and treatment made positive progress.
At present, through innovative service models, all regions have continuously improved the efficiency of referral and accelerated the implementation of hierarchical diagnosis and treatment system. It is understood that Qujiang District, Shaoguan City, Guangdong Province, through the promotion of joint outpatient clinics and joint wards, has sunk some surgical and rehabilitation services to the grass-roots level, opened up the green channel for patients' up and down referral, and shared and distributed the medical business income generated by patients' up and down referral, which has been implemented on a monthly basis to promote the orderly development of two-way referral work.
"Establish a scientific and reasonable referral mechanism to ensure that patients can smoothly transfer from primary medical institutions to hospitals at or above the second level, and form a medical pattern of 'minor illnesses at the grass-roots level, major illnesses to hospitals, and recovery to communities'." Wang Jun said that all regions should further improve the medical service system, clarify the process and standards of two-way referral, and improve the efficiency of referral, Let patients receive timely and effective treatment and rehabilitation services in medical institutions at all levels.
(Reporter Yang Yanfan You Yi Chang Biluo)
