GWMDD [2022] No. 509
All provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps joint prevention and control mechanism (leading group, headquarters) against the COVID-19 epidemic, and all member units of the State Council joint prevention and control mechanism against the COVID-19 epidemic:
In accordance with the relevant requirements of further optimizing and implementing the measures for prevention and control of COVID-19 epidemic, in order to do a good job in health services for key populations of COVID-19 and ensure people's life safety and health, the State Council's Joint Prevention and Control Mechanism for COVID-19 epidemic has studied and formulated the Work Plan for Health Services for Key Populations of COVID-19. It is hereby printed and distributed to you. Please carefully implement it according to the actual situation.
The State Council Responds to New Coronavirus Pneumonia
Integrated Group of Joint Prevention and Control Mechanism for Epidemic Situation
December 9, 2022
(Form of information disclosure: active disclosure)
New Crown Health Service Work Plan for Key Populations
According to the Notice on Carrying out Health Survey of New Coronary Key Populations (GWD [2022] No. 487) issued by the Comprehensive Group of Joint Prevention and Control Mechanism of the State Council, the elderly (65 years old and above, the same below) were investigated and registered by category for their combined basic diseases and vaccination against new coronavirus. This plan is formulated to provide health services for registered key groups.
1、 Clarify the principles of health services
Adhere to the principle of classification and grading, highlight the key points, and divide them into three categories according to the condition of basic diseases, COVID-19 vaccination, and post infection risk: key population (high risk), sub key population (medium risk), and general population (low risk), which are marked with red, yellow, and green respectively, with different colors and different service contents.
2、 Carry out classification and grading services
（1） First class service.
1. Service crowd. General population (low risk, green mark).
2. Service content.
(1) The community (village) is responsible for mobilization and publicity. Those who have not completed the booster immunization and who meet the vaccination conditions after the doctor's assessment shall be guided to vaccinate as soon as possible.
(2) Give play to the role of neighborhood (township), community residents (villagers) committees and their public health committees, grass-roots medical and health institutions, and family doctors, strengthen health education, advocate healthy lifestyles, and do a good job in personal health protection.
(3) Provide consultation services related to COVID-19. The community (village) publicized the current COVID-19 prevention and control policy through small speakers, a letter, WeChat, SMS, APP and other forms, notified each family of key groups with the phone number of the primary medical and health institutions on duty or the phone number of the family doctor, and assisted in health education.
（2） Secondary service.
1. Service crowd. Secondary key population (medium risk, yellow mark).
2. Service content. Carry out secondary services on the basis of primary services.
(1) Those infected with asymptomatic or mild symptoms who are treated at home should report to the community (village) and contact with the grass-roots medical and health institutions in their jurisdiction. The grass-roots medical and health institutions should guide the development of antigen detection, health monitoring, health consultation, medication guidance, etc. through the network, video, telephone, remote or offline methods in combination with the actual situation. After assessment, wearable health monitoring equipment, finger clip pulse oximeter, etc. will be provided for the infected people in need to carry out health monitoring. In case of persistent high fever, dyspnea, finger oxygen saturation<93%, etc., referral will be made as soon as possible. Grass roots medical and health institutions are followed up every 3 days, and the frequency of follow-up can be increased as needed until the end of home treatment observation.
(2) The community (village) assists in the implementation of the management of home treatment of infected persons, assists in medical treatment for those who need regular medical treatment, and assists in providing services such as drug purchase and delivery.
（3） Third level service.
1. Service crowd.
(1) Key population (high risk, red mark).
(2) Key groups with urgent medical needs.
(3) Other people with urgent medical needs, such as infants, pregnant women, etc.
2. Service content. The third level service is carried out on the basis of the second level service.
(1) For the disabled elderly or the elderly with mobility problems who are infected, the method of admission shall be determined after evaluation by the expert team or superior hospital determined by the county (city, district) health department. For those who can live at home after assessment, under the guidance of the superior hospital, the basic medical and health institutions provide necessary services such as health consultation, health guidance, health monitoring, antigen detection, etc. If it is not suitable to live at home after assessment, the primary medical and health institutions shall guide and assist in referral.
(2) Key population (high-risk, red mark) infected people and people with emergency medical needs, community (village) and grass-roots medical and health institutions to assist referral, emergency medical needs can also be through the emergency treatment.
3、 Strengthen organizational guarantee
（1） Clarify the division of responsibilities. Local joint prevention and control mechanisms take the lead and relevant departments implement them according to their responsibilities. Taking the prefecture level and city level as the unit, the health department shall determine the designated (sub designated) medical institutions, establish the superior institutions and professional teams that provide technical support for the grass-roots medical and health institutions, guide the medical and health institutions to provide health management and medical treatment for key groups according to the division of labor, and strengthen the training for relevant institutions to provide classified and graded services. The civil affairs department is responsible for guiding the elderly care homes, child welfare institutions and other key places to strengthen management, mobilizing communities (villages) to do a good job of key population management services under the unified leadership of the local epidemic prevention and control mechanism, guiding residents (villages) committees to cooperate with basic medical and health institutions to provide drugs, antigen testing, contact higher hospitals and other work around the elderly and other high-risk groups. Relevant departments should implement the funding guarantee for the investigation of key groups, graded health services and necessary equipment.
（2） We will strengthen the storage of drugs and antigen test kits in primary medical and health institutions. All regions should strengthen the supply guarantee, ensure that the primary medical and health institutions dynamically reserve Chinese medicine, antipyretic and antitussive drugs and antigen detection reagents according to the list of Chinese medicine recommended by the country and the province, and 15-20% of the total number of service population. Densely populated areas can increase as appropriate. The health department at the county level should organize a team of pharmacists to provide patients with guidance on the use of drugs, such as taboos, compatibility and precautions.
（3） Improve the service level of primary medical and health institutions.
First, strengthen the equipment allocation and upgrading of grass-roots medical and health institutions. Accelerate the construction of fever clinics (outpatient clinics) in township hospitals and community health service centers, and strive to increase the coverage rate to about 90% by the end of March 2023. Improve equipment configuration, including oxygen therapy equipment, portable pulmonary function instrument, finger clip pulse oximeter, wearable health monitoring equipment, etc; Upgrade the electronic health record information system, and encourage qualified people to equip smart health stations for densely populated communities or remote villages.
Second, we will effectively increase the manpower of grass-roots medical and health institutions. It is necessary to establish a system for doctors from relevant departments of urban secondary and tertiary hospitals to visit the grassroots. The leading hospital of the medical consortium (urban medical group or county medical community, the same below) should send doctors to the grassroots. According to the increase of service population and service volume, strengthen the staffing of primary medical and health institutions in due time, and temporarily re employ medical personnel who have retired in the past five years, as well as health professional and technical personnel in other positions, to fill primary medical and health institutions. Township health centers and community health service centers are allowed to hire personnel or entrust tasks of non-medical health services to them through third-party services. It is necessary to establish and improve the telemedicine service network and extend the high-quality medical services of the second and third level hospitals to the grass-roots level through telemedicine.
Third, we will ensure that family doctors of key groups sign up for services. Accelerate to improve the coverage of contracted services for the elderly over 65 years old, achieve full coverage of contracted services for the elderly with basic diseases, and do a good job in health management and health monitoring according to the principle of classification and grading. Strengthen the contact between the family doctor and the contracted elderly to ensure that they or their families can contact the family doctor in time when they need medical treatment.
（4） Implement the management responsibility of the community (village) for key groups. Give full play to the positive role of the grass-roots government, residents' (village) committees and their public health committees, and assist in the daily publicity, education and services of key groups. Establish a direct hotline between communities (villages) and medical institutions and pharmacies. In cities and villages, take the streets and towns as units, allocate or update medical vehicles, and guide and assist in referral.
（5） We will strengthen health management for key groups in rural areas. All localities should strengthen the guidance, support and scheduling of health survey and management of key groups in rural areas. Determine the designated (sub designated) medical institutions at the prefecture level, and define the process and path of referral from township hospitals to designated medical institutions. The county medical community takes the lead in hospitals to assign special personnel or teams to provide necessary support for township hospitals and village clinics to provide services for key populations, such as manpower, technology and equipment. The villagers' committee and its public health committee should coordinate with the village clinic, and mobilize social organizations, social workers, volunteers, and social charity resources to assist the key groups in the area of jurisdiction in purchasing and delivering drugs, and assisting in medical referral; Guide villagers to improve their personal health awareness and self-protection.
（6） Strengthen the management of key institutions such as nursing homes and child welfare institutions. All localities should guide nursing homes and child welfare institutions to formulate classified and graded service plans in the hospital according to this plan, establish a cooperation mechanism with medical and health institutions and pharmacies under their jurisdiction, and clarify the referral process. Medical personnel of medical institutions set up in nursing homes and child welfare institutions or medical and health institutions with which they have a cooperative relationship provide classified and graded services for key personnel. Nursing homes and child welfare institutions should dynamically reserve TCM, antipyretic and antitussive drugs and antigen detection reagents.
（7） Give play to the role of the medical consortium. Actively play the leading role of the medical community of the medical federation, and strengthen the technical guidance for the construction and operation of fever clinics (outpatient clinics) of its member units. Coordinate the deployment of personnel within the Medical Federation, assign professional forces to guide and support the daily diagnosis and treatment of fever clinics (outpatient clinics) in grass-roots medical and health institutions. The two-way referral channel should be unblocked, and the hierarchical diagnosis and treatment should be well connected. The leading hospital should set up a special treatment team composed of respiratory department, paediatrics, critical care department, traditional Chinese medicine department and other relevant departments, and strengthen the technical support, training, guidance and quality control for the grassroots.
（8） Encourage the participation of social forces. We will coordinate the efforts of all parties, encourage and guide social forces to participate in the primary medical service guarantee, expand medical service resources, and meet the medical and health service needs of the masses.
