How many medical institutions can a county build?

From April 2065438 to April 2007, the General Office of the State Council issued "Guiding Opinions on Promoting the Construction and Development of Medical Consortium", proposing to set up a county-level medical consortium, focusing on exploring the integrated management of counties and townships with county hospitals as the leader, township hospitals as the hub and village clinics as the basis, and effectively connecting with the integrated management of villages. Give full play to the role of county-level hospitals as a link between urban and rural areas and as a leader in the county, form a division of labor and cooperation mechanism for county-level rural medical and health institutions, and build a three-level linkage county-level medical service system.

Through more than four years of exploration and construction, the number of county doctors in China has increased rapidly, and the county medical service capacity has been significantly improved. According to the data released by the National Health Commission, by the end of March, 202 1 4,028 county-level medical institutions had been built nationwide. What benefits does the county medical system bring to the grassroots? Recently, our reporter interviewed this.

County hospitals can cure serious diseases.

After the county hospital's specialized treatment ability has been improved, many seriously ill patients no longer need to be transferred to higher-level hospitals, and the grassroots people have received tangible benefits.

Not long ago, Aunt Wang, who lives in Xianxia Town, Ningguo City, Xuancheng, Anhui Province, suddenly fainted at home and looked ugly. My son quickly sent her to Ningguo People's Hospital for neurosurgery treatment.

"My mother is over 60 years old and things don't look very good." Aunt Wang's son said anxiously. Chief physician Hu, who was in charge of consultation, comforted and examined Aunt Wang. After a simple examination, Hu thought that Aunt Wang was probably suffering from cerebral hemorrhage, so she quickly arranged for a CT examination. Soon, Aunt Wang was diagnosed with cerebral hemorrhage caused by ruptured anterior communicating artery aneurysm and needed surgery as soon as possible.

On the same day, Hu Wei performed interventional embolization of communicating aneurysm for Aunt Wang, and her condition turned to safety. "I didn't expect such a big operation to be done in the county hospital." Aunt Wang said.

"Aneurysmal rupture is now a common critical disease." Hu analyzed that the main clinical manifestations of patients are sudden headache and even coma, and basically all of them need surgery, most of which are vascular interventional surgery, and a few need craniotomy. The mortality of this disease is relatively high, so it is necessary to avoid moving the patient as much as possible, because bumping will increase the risk of rupture, and once it ruptures again, the mortality will rise to 80%. Therefore, it is very important for patients to receive treatment nearby in time.

Hu introduced that Ningguo People's Hospital is a county-level hospital. In the past, some difficult operations could not be performed due to the lack of experts and medical equipment. When you meet a critically ill patient like Aunt Wang, you often suggest that the patient be transferred to a big hospital. Today, this situation has been completely changed.

In 20 19, Ningguo City issued the Implementation Plan for the Construction of Compact County Medical Institutions in Ningguo City, integrating 13 township hospitals, 6 street community health service centers and village clinics under its jurisdiction, and Ningguo People's Hospital and Municipal Hospital of Traditional Chinese Medicine took the lead in establishing two compact medical institutions. In order to improve the diagnosis and treatment capacity of county-level hospitals, Ningguo Municipal Government invested18.2 million yuan in 2065438 and1/7.2 million yuan in 2020 respectively. In addition, the Ningguo Municipal Government has reached a cooperation with the Second Affiliated Hospital of Anhui Medical University, allowing experts to sit in county-level hospitals and hold lectures. The medical staff of county-level hospitals can go to large hospitals for training and exchange.

Under the guidance and training of experts from the Second Affiliated Hospital of Anhui Medical University, the professional level of doctors has been greatly improved, and they can gradually complete some difficult operations independently. "In 2020, the number of operations in this department exceeded any previous year, and there were more than 30 cases of aneurysm rupture alone." Hu said:

"After the improvement of the specialized treatment capacity of county-level hospitals, many seriously ill patients no longer need to be transferred to higher-level hospitals, and the grassroots people have received tangible benefits. If you go to a big hospital for treatment and travel long distances, you may delay your illness. " Hu said:

Grassroots talents can stay.

In order to retain talents, rural medical and health institutions should not only raise salaries, but also provide more career development opportunities for medical staff.

In Qianxiang Town, Dongyang City, Zhejiang Province, a 70-year-old man had a sudden myocardial infarction. The son went straight to the town health center with his mother, immediately launched an emergency rescue plan, opened a green channel, and carried out cardiopulmonary resuscitation ... After 20 minutes of professional rescue by the emergency team, the vital signs of the elderly gradually stabilized. "Sudden myocardial infarction cases rescued by township hospitals are rare. If the operation is improper or the rescue is a few minutes late, there may be no hope. " The director of Dongyang Medical Management Center should be the first to say.

Thousands of townships are located in remote mountainous areas of Dongyang City. We must strive to say, "The emergency team of the hospital has participated in the modular training launched by Dongyang Medical College for many times, and conducted a simulated rescue drill every month under the professional guidance of experts from higher hospitals. The first-aid team members have mastered excellent first-aid techniques in the normalization training. "

Before the establishment of medical institutions, the diagnosis and treatment ability of township hospitals was not strong, and many villagers liked to go to the county to see a doctor, so there were few hospitals. In order to solve the situation, Dongyang Medical College has set up eight quality control centers, including medical treatment, nursing, hospital sensation, pharmacy, inspection and radiation, which are inspected and guided by leading hospitals at the county level every quarter, so as to promote the medical quality of township hospitals and promote the sinking of high-quality medical resources according to the standards of county hospitals. According to statistics, last year, six leading hospitals at the county level sent experts to visit 9000 people at the grass-roots level, and improved the grass-roots service capacity through the "mentoring system".

On this basis, Dongyang Medical College established a "talent pool", which changed the original policy of independent recruitment from grass-roots medical units to unified recruitment, unified training, unified deployment and unified management in the whole city, in order to solve the problem of "unable to recruit and unable to retain people" in township hospitals. "We have all newly recruited professional and technical talents and graduates trained in orientation into the' talent pool' management. After being trained by leading hospitals, they will be uniformly deployed by Dongyang Medical and Sports Management Center, and they will be rotated in urban areas, plains, semi-mountainous areas and mountainous areas for 8 years, and different wage distribution coefficients will be given according to regional differences." Should be the first to say.

Through a series of measures to "retain people", the phenomenon of "unable to recruit and retain people" in primary medical institutions has been effectively alleviated, and the ability of primary medical services has been continuously improved. After the construction of medical facilities in Dongyang City started, the number of outpatient and emergency services in primary medical institutions in the city increased from10.7 million in 2065 to 250,000 in 2020, with an increase rate of 43.3%.

Ding Hong, deputy dean of the School of Health Management of Anhui Medical University, believes that the distribution of primary medical and health resources in China is uneven, and there is a big gap between counties and townships. Promoting the construction of county medical institutions is in line with China's reality, which is conducive to improving the service capacity of township hospitals, forming a reasonable order of graded diagnosis and treatment, and realizing "common diseases do not leave the countryside"

"County medical practice can't engage in formalism, and it can't fully play its role without an efficient management system." Ding Hong said that it is necessary to unify the internal systems, services and standards of county-level medical institutions, realize the unified management of people and property, truly enjoy high-quality resources and improve the overall medical service level. In order to retain talents, rural medical and health institutions should not only raise salaries, but also provide more career development opportunities for medical staff.

Chronic disease management is more efficient.

Family doctors should not pursue the signing rate, but should "make an appointment to sign contracts" and do a good job in signing services for key groups and special groups such as chronic diseases.

In March last year, Aunt Wu, a villager in Yankou Village, Liushi Street, Dongyang City, was diagnosed with hypertension. Since then, Wang Caifang, a public health doctor in the street health service center, has become her contracted family doctor, and goes to her home every week to follow her physical condition.

"Very thoughtful, not only a doctor but also a friend." Aunt Wu said that she used to forget to take medicine, but now with Wang Caifang's persuasion, her condition has been well controlled. Not only that, she told reporters that the reimbursement rate of township hospitals is high, the cost is low, and the expert number of county hospitals can also be hanged.

In order to strengthen the management of chronic diseases at the grass-roots level, in recent years, Dongyang Medical Institute has implemented a series of measures: joint consultation between county-level hospital experts and general practitioners in grass-roots medical and health institutions; The list of drugs for chronic diseases is sinking, allowing patients with "old chronic diseases" to buy "county-level drugs" in primary medical institutions.

Wang Caifang introduced that over the past year, experts from leading hospitals at the county level came to the street health service center every week. For patients with serious illness, they can also be directly transferred to county hospitals for further treatment through the two-way referral platform, which saves many intermediate links. Not only that, experts will be organized to give lectures, receive consultation and answer questions every month, so that villagers can understand the harm and prevention methods of chronic diseases.

In 20 19, Dongyang City incorporated medical institutions into the public health management system, and established a chronic disease prevention and control system covering urban and rural areas by means of information technology. Nowadays, any patient over the age of 35 must have his blood pressure measured before seeking medical treatment. It should be introduced first. If the blood pressure value is found to be abnormal, the information platform will push the patient information online to the community doctor for a second review. After the review, it is clear that the confirmed patients will be included in the health management of hypertension patients, forming a closed-loop management, and community doctors will conduct standardized management according to the classification of patients. Diabetes, on the other hand, detects abnormal blood sugar information from medical institutions and sends it to community doctors for review. Only after a clear diagnosis can patients be brought into unified management.

In Dongyang City, the diagnosis and treatment information of patients with chronic diseases such as diabetes and hypertension has been interconnected in the county. Personal health records can be comprehensively consulted in doctors' clinics, and patients can flexibly choose to see a doctor in any member hospital, which reduces repeated examinations, greatly reduces the burden of patients seeking medical treatment and improves the efficiency of chronic disease management.

Ding Hong believes that the management of chronic diseases and the prevention and control of infectious diseases cannot be separated from the integration of medical care and prevention. In the construction of county medical institutions, the basic public health system should be integrated with the basic medical service system. Among them, family doctor team signing can play a greater role. Family doctors should not pursue the signing rate, but should "make an appointment to sign contracts" and do a good job in signing services for key groups and special groups such as chronic diseases. In addition, it is necessary to break through the information barrier between county medical institutions. At present, from a technical point of view, it is no problem to realize inter-agency interconnection and information sharing. Only by sharing information can the efficiency of chronic disease management be further improved, and the disease control department can effectively monitor the incidence of infectious diseases and take timely prevention and control measures. (Reporter Shen Shaotie, Xu Jing, Dou Yuyang)