| No one is immune to illness in life, and people have had the experience of waiting in a hospital line. In order to solve the problem of medical care for the public, since July of this year, Shaanxi has carried out comprehensive diagnosis and treatment. How is progress and effectiveness? Reporters conducted an investigation in Xi'an.
Recently, the General Office of the State Council issued the Guiding Opinion on Promoting the Construction of Graded Diagnosis and Treatment System, which requires all pilot cities and provinces of public hospitals to carry out graded diagnosis and treatment pilot projects in 2015, gradually improve the policy system of graded diagnosis and treatment by 2017, and comprehensively enhance the capacity of graded diagnosis and treatment services by 2020.
Since July this year, Shaanxi has launched the implementation of grading diagnosis and treatment in the whole province. Now, this work has been implemented for nearly three months. What is the actual effect? What are the problems? In this regard, the reporter visited the investigation and found several noteworthy phenomena.
The patient ran with the doctor, and the experts brought the fans group.
On September 22, Uncle Liu, who lives in Zhangba East Road, Xi'an, got up early and rushed to the Community Health Service Center of Yanta District Electronic City. Every Tuesday, Wang Fanrong, an expert in digestive medicine in the Affiliated Hospital of Jiaotong University, sits here without waiting in line or registration fee. It doesn't take long for Uncle Liu to sit in front of the expert.
"We are all old patients of Dr. Wang. They used to go to the hospital to register before and after a long time. Since she was told to go to the community every week, we would never run a big hospital again. " Said uncle Liu.
Celest Chong, a 73 year old, is also a victim of the "big hospital". At the Nanyuanmen Community Health Service Center in Fanxiang, the reporter met him who was undergoing rehabilitation treatment. He was so energetic and his mouth was clear that it was difficult to see that he had suffered from cerebral infarction for many years. "My old man can now be restored to this. We are very happy. In the past, he could not walk or speak. Zhang Yuhua's wife smiled and said, "We are running to Director Zhang to do our duty to the patients."
Director Zhang Jizhou, deputy director of physiotherapy department of Xi'an First Hospital, led a team to be sent here. "Although it is a community hospital, our rehabilitation ward is positioned as a secondary hospital standard and an intermediate link between tertiary hospitals and the community." Zhang Jizhou explained.
For a long time, our country has been implementing the three level of diagnosis and treatment system. But grass-roots hospitals are short of medicine, outdated facilities, weak medical level, and large hospitals through the siphon effect, a large number of medical resources, resulting in polarization. How to improve this problem is the key.
"After the implementation of grading treatment, many experts told us that now, ah, my patients do not come to the big hospital, know that there are many people here, are directly to the community to find me." Yan Fang, director of the Grading Diagnosis and Treatment Office of Xi'an First Hospital, mentioned the details, laughing and saying, "Only by teaching community doctors by experts and improving the technical level of medical staff in grass-roots community hospitals, can we better implement the first visit at the grass-roots level and effectively treat patients in the community flow."
In the Grading Clinic Office of the First Affiliated Hospital of Jiaotong University, Liu Qing, deputy director, showed the reporters several calligraphy pictures. "All of them were written by our veteran experts at the grass-roots level. They maintained good relations with the community residents, and even established a"fan group". Where the doctor goes, where the patient goes. This recognition and support is also motivating for doctors and the value of life is reflected. "
From the data of Yanta District Health Bureau, we can also see that since the establishment of the Medical Association, from March 9 to the end of July, the total number of patients in Yanta District community was 86 539, and the outpatient volume of community health service centers increased by 56.62% on average compared with the same period last year.
Two-way referral is one-way: get up and go down.
In the ideal state of planning, community hospitals should undertake prevention, science popularization, health care and treatment of some common diseases and frequently-occurring diseases, divert patients from large hospitals, alleviate medical pressure. If the patient's condition exceeds the diagnostic pressure, he is referred to a superior hospital for further treatment, and when the condition is stable, he is transferred back to the primary medical institutions. This is the "Two-way Referral" which is often mentioned in the grading treatment.
Taking Xi'an as an example, in many medical associations established in various urban areas, bidirectional referral has become a work of vigorous implementation. For example, the First Affiliated Hospital of Xi'an Jiaotong University and the First Hospital of Xi'an City have opened a "green channel": when patients are first diagnosed in the community, and community doctors can not treat, they can issue a referral form, through telephone contact, no appointment, registration and queuing, priority to enter the hospital for treatment.
But in interviews, reporters also found that due to the voluntary principle of two-way referral, now the two-way referral has almost become a one-way referral. "Patients are willing to turn around because the superior hospitals have good medical conditions. But it's hard to get down again. A person in charge of a community health service center said frankly, "Patients usually see a doctor where they will not be discharged until they are cured, willing to spend more money and not willing to toss about."
In the neurology ward of a third-class hospital, the doctor persuaded Ms. Zhang, who was already in stable condition, to go to the community rehabilitation treatment, but she was very firm, "It was very difficult to get a bed in your hospital, never go down." Some patients thought, "I had surgery in this hospital, and the doctor was responsible for me. If it turns out, there is a problem. Who should I turn to? What if we delay the disease? "
In this regard, many doctors also said helplessly, "We still have many critically ill patients waiting for bed, but even so, can not force patients to refer, because there is no standard, the patient can be transferred to what extent, in order to avoid referral process medical disputes or medical safety problems, we also on We can only make this step.
In addition to the concept of patients is difficult to change, for community health service centers, on the one hand, a serious shortage of people, on the other hand, the workload is heavy, undertaking the establishment of health records for the service area population, free physical examination for the elderly over 65 years old, vaccination of children and other work. Therefore, some community health centers are not "active" for outpatient clinics, directly telling patients "can not see the doctor", pushing patients to higher hospitals.
"Two-way referral can not be achieved overnight." In Liu Qing's opinion, since they established the Medical Association, they have spent a lot of energy on this work, printing brochures, setting up a health education expert group attached to the first-year college, and carrying out propaganda activities in the community, "is constantly telling everyone what is classified diagnosis and treatment? What is the process? What convenience has been brought to you? This is a process that requires long-term adherence. "
Barriers to medical informatization restrict when to take the "Internet +"
Reporters found in the interview process, whether it is community health service centers, or secondary and tertiary hospital medical staff, all accidentally emphasized the constraints of a hierarchical diagnosis and treatment of a problem - the medical information system is not connected.
At present, the major hospitals have their own information systems, and adopt advanced management tools, such as the first hospital in Xi'an, and so on. All hospitals have already implemented the measures such as appointment registration, Alipay payment and so on. But these information systems are also local area networks, which are limited to the internal use of hospitals.
The information between hospitals at different levels is not butted, and the information needed to be transferred to patients should be re copied and input. Information entered in community visits is not seen in grade three hospitals. " A third-tier hospital grading treatment of the responsible person told reporters, "At present, the common situation is to refer to the community directly and related departments telephone contact, the lack of information platform to record the detailed number of referral. Sometimes we count the number of people manually, and the Department of the hospital looks at it and says, "How come you're missing so much?"
In addition, some grass-roots medical institutions lag behind in information construction, in addition to simple registration, fees, medicine, and did not achieve information management.
In the E-City Community Health Service Center, a less than 10 square metre office is filled with community residents'health records from top to bottom. Besides filling out paper files, three staff members need to input them into their "general practice system".
If we want to input more than ten thousand service population information, we can clearly see the huge workload. But in the view of Zhu Hongbin, director of the center, this work is very necessary, "through the construction of information technology, medical treatment has become more standardized, patient treatment, medication, health records at a glance."
At present, 10714 patients with hypertension and diabetes are managed here, 85.38% of hypertension and 81.29% of diabetes are managed regularly; 9114 elderly people over 65 years of age have been grounded, and 8769 files have been established, with a file-building rate of 96%. However, Zhu Hongbin also has some regrets. These information can only be seen in the center for the time being, and can not be found. Butt the superior hospital.
In the face of these problems, the First Affiliated Hospital of Jiaotong University is also actively building a "regional health information platform", hoping to connect with the community and secondary hospitals as soon as possible, grasp the health status of residents, and carry out effective tracking management.
At present, a large number of Internet technologies have been applied to medical and health systems, such as remote consultation services, online diagnosis, family rehabilitation and other forms. But if we can speed up the construction of information technology, build a large data platform on the Internet, through effective observation and monitoring, establish online and offline combination, build a collaborative medical and health services community platform, can also effectively promote the grading of medical work.
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