In July 2023, the National Development and Reform Commission, the National Health Commission, and the State Administration of Traditional Chinese Medicine jointly released the fifth batch of national regional medical center project lists, including 49 projects including Peking University People’s Hospital Shijiazhuang Hospital and Tianjin Cancer Hospital Qinhuangdao Hospital. project. The purpose of these national regional medical center construction projects is to improve the treatment capabilities of complex and serious diseases in each region.
In March 2023, the General Office of the Central Committee of the Communist Party of China and the General Office of the State Council issued the “Opinions on Further Improving the Medical and Health Service System”, calling for promoting the expansion of high-quality medical resources and balanced regional layout, building a high-quality and efficient medical and health service system with Chinese characteristics, and continuously strengthening The people’s sense of gain, happiness and security.
Promoting the sinking of high-quality medical resources is an important step in promoting the expansion of high-quality medical resources and balanced regional layout. In recent years, our country has vigorously built national regional medical centers and established various forms of medical alliances to promote the sinking of high-quality medical resources and enhance the medical service capabilities in underdeveloped areas, grassroots and rural areas, so that the people can enjoy high-quality, high-quality medical care at their doorsteps. Efficient medical services.
At present, what is the quantity, scale and layout of high-quality medical resources in my country? What useful explorations have been carried out by various regions and departments? How to better promote the sinking of high-quality medical resources in the future? The reporter recently conducted interviews and research in Yunnan, Hubei, Fujian and other places.
The practice of a national regional medical center construction project——
Famous doctors do a good job of “teaching, helping and guiding”
“Thanks to the doctors in Fuwai, Yunnan, the operation was particularly successful.” Recalling the sudden cardiovascular disease he suffered while traveling in Yunnan 7 years ago, the 79-year-old Uncle You still has lingering fears.
“At that time, my wife and I visited a scenic spot, and suddenly there was a ‘tearing pain’ in the chest and back, and I fainted on the spot.” Uncle You said that after being rescued at the local hospital, he was diagnosed with aortic dissection and was subsequently transferred to Fuwai Hospital of the Chinese Academy of Medical Sciences, Yunnan Hospital (hereinafter referred to as Yunnan Fuwai).
At that time, Yunnan Fuwai was put into operation not long ago. It was jointly built by the Yunnan Provincial People’s Government and Fuwai Hospital of the Chinese Academy of Medical Sciences (hereinafter referred to as Beijing Fuwai). It was the only tertiary-A cardiovascular specialist public hospital in Yunnan Province. In 2019, it became the first batch of national regional medical center construction pilot units.
“The old man’s arterial tear is located on the small curvature of the aortic arch, almost on the same plane as the left subclavian artery, and the anatomical conditions are difficult.” Guo Yuanyuan, director of vascular surgery in Fuwai, Yunnan, said, “Such an operation is difficult. We have done this with Beijing Fuwai After discussion with external vascular surgery experts, the experts decided to fly from Beijing to Kunming to perform surgery on the elderly man.”
The operation was successful. On the second day after the operation, Uncle You was able to get out of bed and move around.
Guo Yuanyuan told reporters that in the first two years since Yunnan Fuwai was established, because the local medical team was relatively immature and faced difficult critical illnesses, experts from Beijing Fuwai often went to Yunnan to perform surgeries and demonstrate to everyone.
Today, Guo Yuanyuan has successfully “started her career”. For the same difficult disease of aortic dissection, Guo Yuanyuan has been able to serve as the chief surgeon and successfully cured several patients.
Niu Guodong, assistant to the dean of Yunnan Fuwai, said that Yunnan Fuwai has completely transferred the management rules and regulations of Beijing Fuwai, including the discipline structure, medical management model and information system. Beijing Fuwai has long-term staff stationed in clinical and administrative management, and serves as the rotating head of the department to guide the team in Yunnan Fuwai to carry out daily diagnosis, treatment and management work. At present, more than 820 experts from Beijing have rotated work in Yunnan, and more than 65 experts are guaranteed to work in Yunnan on a long-term basis. In addition, almost all clinical and administrative staff of the hospital recruited locally in Fuwai, Yunnan are arranged to go to Fuwai, Beijing for further training.
Training is not only the exchange of technology, but also the dissemination of Fuwai culture. “In Fuwai, we put life first. We teach young doctors that doctors who can only perform surgeries can only be called technicians, not good doctors. Knowledge will become outdated, but a serious and rigorous attitude towards patients and the best care for patients The spirit of service will never go out of style, and only those who meet these two requirements can be called a good doctor.” Niu Guodong said.
As a young department director, Guo Yuanyuan admitted that her growth has benefited from the training mechanism for young doctors in Fuwai, Beijing. “During my training period, experts sometimes served as my first assistant in surgery, guiding me from the side.”
In Fuwai, Yunnan, many young doctors like Guo Yuanyuan are growing rapidly, and a number of advanced medical technologies are popularized: in 2023, third- and fourth-level surgeries will account for 95.47%, including 622 coronary artery surgeries and 772 congenital heart disease surgeries… …
“In the future, Yunnan Fuwai and Beijing Fuwai will cooperate with more universities to build platforms, rely on high-quality medical resources to carry out scientific research and teaching, improve the talent service management system, and enhance talent training and attraction capabilities. At the same time, they will enhance the ability to export talents to produce blood. , drive the clinical diagnosis and treatment level of hospitals at all levels in the province to improve together, and implement the national policy of sinking high-quality medical resources.” Niu Guodong said.
At present, our country has identified five batches of 125 national and regional medical center construction projects, covering all provinces with weak medical resources. Data released by the National Health Commission show that since the implementation of the project, more than 1,400 diagnostic and treatment technologies have been transferred to the importing provinces, filling more than 300 provincial medical technology gaps, and the number of inter-provincial medical treatments in relevant provinces has dropped significantly. Drawing on the experience of building national regional medical centers, each province is also building provincial regional medical centers. During the “14th Five-Year Plan” period, the state will support various localities in building about 120 provincial-level regional medical centers to promote the sinking of high-quality medical resources in the province.
Exploration of an urban medical consortium——
Expert consultation goes into the community
“Eat more whole grains, eat less food heavy in oil and salt, and be careful with seafood.” said Cao Ji, deputy chief physician from the Department of Neurology, Wuhan Central Hospital, in the general clinic of the Labor Street Community Health Service Center, Jiang’an District, Wuhan City, Hubei Province. While Qing was conducting consultations and issuing prescriptions, he also reminded patients to eat healthily.
The 62-year-old patient Wang Jianping nodded repeatedly. Because he suffers from chronic diseases such as high blood pressure, migraines, and diabetes, Wang Jianping needs regular check-ups. “I used to go to big hospitals in the city for medical treatment, but now I am used to coming here. The main reason is that it is convenient. I can find the ‘expert number’ of a tertiary hospital at my doorstep.” Wang Jianping said that with expert consultation and guidance, he His underlying diseases have been stably controlled, and some symptoms have been relieved a lot.
Starting in 2017, Wuhan Central Hospital and Jiang’an District Labor Street Community Health Service Center have jointly built a “close medical alliance”. Every week, Wuhan Central Hospital sends five doctors from different departments to visit the Labor Street Community Health Service Center for one day of regular consultation.
“We are not only responsible for consultations, but also bring medical staff from community health service centers in the area to share some experience in medical treatment.” Cao Jiqing said that the community health service center will also organize medical staff to study at Wuhan Central Hospital from time to time. , improve the diagnosis and treatment level of grassroots doctors through two-way interaction.
In order to ensure the long-term and stable development of the medical consortium, Wuhan Central Hospital has also assigned a manager to be stationed at the community health service center to be responsible for the daily operations of the center. “My main job now is at the Labor Street Community Health Service Center. I am responsible for connecting with the central hospital so that resources within the medical consortium can communicate.” said Zhu Jiang, director of the Labor Street Community Health Service Center.
In recent years, Wuhan Central Hospital has transferred more and more medical resources to medical consortium units, and now has formed different types of medical consortiums covering 38 medical institutions. Among them, Wuhan Central Hospital pioneered the intelligent full-process blood sugar management model, which unites more than 20 medical consortium units to carry out two-way referrals and implement hierarchical diagnosis and treatment, benefiting more than 200,000 residents and integrating regional chronic disease health management services.
In order to allow community residents to enjoy high-quality medical resources at their doorsteps, Wuhan Central Hospital and Labor Street Community Health Service Center have also broken down information barriers and established a “joint ward”. Doctors from the community health service center log in to the Wuhan Central Hospital’s “Cloud Clinic” “The system can issue a check list to the patient.
“As long as the examinations that Wuhan Central Hospital can do, such as CT, DR (digital X-ray), B-ultrasound, electrocardiogram, etc., can also be done at the community health service center. And the patient’s information will be immediately transmitted to Wuhan Central Hospital. The doctor will give the diagnosis results and medical advice.” Zhu Jiang said that when the patient’s physical indicators appear abnormal, such as excessive blood sugar data, the system will automatically alarm, and the hospital will immediately arrange relevant doctors to conduct remote diagnosis and treatment or consultation guidance. In the event of a dangerous situation, patients treated at the community health service center can be transferred to Wuhan Central Hospital at any time.
“In the next step, we will also set up some specialist clinics for geriatric diseases in community central hospitals. Based on the construction of intelligent full-process blood sugar management centers and sub-centers, we will improve the construction of regional diabetes prevention and treatment network systems, realize information exchange between hospitals and medical consortium units, and carry out diabetes Collaborative and standardized management of patients can also remotely guide the standardized diagnosis and treatment of diabetes at the grassroots level,” Zhu Jiang said. In addition, relying on the Internet hospital platform, Wuhan Central Hospital further explores cooperation with grassroots medical consortium units to jointly improve out-of-hospital follow-up management extended services and achieve hierarchical diagnosis and treatment and two-way referrals.
In April 2017, the General Office of the State Council issued the “Guiding Opinions on Promoting the Construction and Development of Medical Consortiums”, proposing that the construction of medical consortiums (hereinafter referred to as medical consortiums) is an important step and institutional innovation in deepening medical reform. Taking advantage of the concentration of high-quality resources in tertiary public hospitals, we can use technical assistance, talent training and other means to exert a technical radiation and leadership role at the grassroots level. In cities at or above the municipal level divided into districts, tertiary public hospitals or hospitals with strong business capabilities will take the lead and cooperate with community health service agencies, nursing homes, professional rehabilitation institutions, etc. to form a management model of resource sharing, division of labor and collaboration. Starting in 2019, the National Health Commission has launched pilot projects for the construction of urban medical consortiums in 118 cities, and the construction of urban medical consortiums has been accelerated.
The development of a compact county medical community——
People have “medical” support at home
“Lao Wang, did you forget to come for a follow-up consultation and prescribe medicine again? You can’t ignore your health.” In the morning, a rapid ringtone rang on his cell phone. Wang Huihuang, a villager in Gaoqiao Village who was resting at home, quickly picked up the phone. The head is Zhang Chunmian, deputy director of Gaoqiao Branch of Shaxian District General Hospital, Sanming City, Fujian Province.
“Oh, look at my memory! I’ll be there soon, please wait a moment.” Wang Huanghuang rolled out the electric car from the foyer, put on his medical insurance card, and rushed to Gaoqiao Branch. In less than 10 minutes, Wang Huihuang sat in the clinic, where Zhang Chunmian was already waiting. Asked about his current situation, looking at his complexion, and measuring his blood sugar, Zhang Chunmian said: “My blood sugar is under good control. This is the medicine for this month. I have to continue taking it. Remember to come for a review at the beginning of every month!” This made Wang Huihuang, who has suffered from diabetes for 5 years, feel sad. More at ease.
“Now that the level of township health centers has improved, it is more convenient for people to see a doctor!” Wang Huanghuang said quickly, describing the outstanding results of the construction of the regional medical community in Shaxian County. In 2017, the original Shaxian Hospital and Shaxian Hospital of Traditional Chinese Medicine merged to form Shaxian General Hospital (now Shaxian District General Hospital). At present, Shaxian District General Hospital has 12 branches (township health centers), 2 community health service centers and 132 village health clinics, forming a compact county medical community, responsible for basic medical care and basic care for 260,000 people in the region. Public health services, preventive care and other responsibilities.
“After the establishment of the general hospital, the oncology department was established with the help of the Fujian Provincial Cancer Hospital, which standardized and improved medical capabilities. At the same time, medical staff were dispatched to support the construction of township branches, and the strength of the branch hospitals was greatly strengthened.” Xie Xianjin, director of the Shaxian District General Hospital introduce. Zhang Chunmian told reporters that at the Gaoqiao branch, the types of diseases that can be diagnosed and treated have increased from 53 to more than 80, enabling general diseases to be treated nearby, and patients no longer need to travel to counties dozens of miles away for treatment.
“Had it not been for the doctors who went to the countryside five years ago, my problem would not have been discovered as early as possible.” Wang Huihuang recalled that in the summer of 2019, medical staff from Gaoqiao Branch went to the countryside for inspections, and his abnormal blood sugar indicators attracted the attention of the medical staff.
After the establishment of the county medical community, Shaxian District General Hospital established a health management department, which clarified the health management idea of ”focusing on the grassroots and focusing on prevention.” For example, we have continued to explore the health management of the elderly and patients with chronic diseases, established four major management centers for hypertension, type 2 diabetes, severe mental disorders, and tuberculosis, and established a collaborative division of labor mechanism between the main hospital and grassroots branches to provide high-quality care for patients with chronic diseases. Serve.
Wang Huihuang was included in the health management list of Gaoqiao Branch. He took out the bill and said, “Excluding the medical insurance payment for monthly follow-up consultations and prescriptions, the personal burden for a single prescription is not heavy.”
On the first floor of the small building of the Gaoqiao branch, the newly opened traditional Chinese medicine clinic was crowded with people, and various services such as acupuncture and traditional Chinese medicine decoction were carried out in an orderly manner. “With traditional Chinese medicine health care at our doorstep, we can rest assured and worry less!” Chen Alan, who is in his 60s, has just finished treatment.
In Xia Mao Town, 15 kilometers away from Gaoqiao Town, Deng Shengbing, deputy director of Xia Mao Branch, said that the newly built hemodialysis center was officially opened in August last year. More than 10 kidney disease patients in the surrounding area no longer have to travel to the district for dialysis three times a week. “In addition, we established a chest pain center in 2020 and have successfully treated 8 chest pain patients so far.” Deng Shengbing said.
“Since the establishment of the county medical community in 2017, Shaxian District has incorporated 13 major medical and health projects into the district’s practical projects for the people, investing a total of 238 million yuan, introducing 17 professional and technical talents and 108 targeted training talents to strengthen grassroots The construction of medical institutions has basically enabled the people to have medical support at home,” said Xu Fashui, director of the Shaxian District Health Bureau.
In April 2017, the General Office of the State Council issued the “Guiding Opinions on Promoting the Construction and Development of Medical Consortiums”, which proposed the establishment of medical communities mainly in counties. Focus on exploring integrated county-township management with county-level hospitals as the leader, township health centers as the hub, and village clinics as the basis. Give full play to the role of county-level hospitals as a link between urban and rural areas and as a county leader, form a division of labor and coordination mechanism for three-level medical and health institutions in counties and rural areas, and build a three-level linkage county medical service system. After several years of exploration and construction, my country has built more than 4,000 county medical communities, and has piloted the construction of compact county medical communities in more than 800 county-level administrative districts.