Gansu logic of strengthening county and district medical service

Gansu Province stretches more than 1600 kilometers from east to west, with mountains and ditches deep. It is not convenient for people in mountain villages to go to the provincial capital to see a doctor. In recent years, the local government has made great efforts to strengthen the county and district medical service. In the assessment of the service capacity of county-level hospitals in China in 2019 released in July, the basic standards and recommended standards of county-level hospitals in Gansu Province ranked 22nd and 21th respectively; the two rankings of county-level hospitals in poverty-stricken counties jumped to 14th. < / P > < p > in the past, it ranked last but now it is in the middle. This is due to a series of innovative measures taken by Gansu Provincial Health and Health Commission in terms of discipline system construction, talent team construction and information construction. In novel coronavirus pneumonia control, 25.52% of the patients were discharged from the county level hospital, and the rate of external referral decreased from 12.45% in 2014 to 12.45% in 2019. Guo Yufen, director of Gansu Provincial Health Commission, accepted an exclusive interview with our newspaper and interpreted a set of development logic behind these data. < / P > < p > “in recent years, the country has continuously promoted the construction of grass-roots hardware, and the infrastructure of county hospitals is getting better and better. At present, the most important work is to strengthen the software, including improving the discipline construction, improving the ability of diagnosis and treatment, especially to retain talents. We propose that, according to the primary needs of the grassroots people, we should start from the critical care discipline, promote the development of relevant weak disciplines, and establish a county-level and village level life treatment network. ” Guo Yufen said. Since 2014, Gansu Provincial Health and Health Commission has built intensive care medicine departments in 30 county hospitals every year, with an investment of 2.5 million yuan per county. By 2017, 75 poverty-stricken counties in the province have achieved full coverage of critical care medicine, and all counties and districts have the ability to provide critical care medical services in 2019. < / P > < p > “we organized provincial experts to formulate the construction standards of the local intensive care medicine department according to the specific situation of the county population and the size of the county hospital, including how large the Department is to be built, what kind of equipment is configured, what kind of business is to be carried out, and how much medical care is needed. After the completion of the capital construction, the provincial expert group will go to the county by county to train and supervise the medical staff Guo Yufen. At the same time, Gansu Province has established 56 quality control centers relying on various specialties of provincial hospitals. The expert group of each quality control center carries out medical quality supervision on county-level hospitals every year. Only this year, it has carried out more than 200 times. < / P > < p > on this basis, in 2018, Gansu Province launched the construction of “five county-level emergency and critical care centers”. At present, there are 17 chest pain centers, 45 stroke centers, 25 trauma centers, 75 critical pregnant and lying in women treatment centers, and 77 critical newborn treatment centers in 86 counties and cities of the province. < / P > < p > “the five major treatment centers have formed a hierarchical prevention and treatment system, from pre hospital first aid, grass-roots referral to multi-disciplinary joint diagnosis and treatment in hospital. In the past, in some grass-roots areas, the mortality rate of newborns and pregnant women was very high. Now there are critical maternal and neonatal treatment centers, which have saved the lives of many babies and pregnant women. For the critical patients who need emergency treatment such as cardiovascular disease, stroke, trauma and so on, to seize time is to seize life. With the escort of the rescue center, the doctors in the county hospital dare to do such a big operation. ” Guo Yufen expressed satisfaction. < / P > < p > since 2018, the province has started the construction of 5 medical centers, including ECG, inspection, pathology, imaging, disinfection and supply. At present, five county-level medical centers have been established in 70 counties of the province. Three centers, including inspection, ECG and imaging, have been able to connect with more than 70% of the township hospitals in the county. < / P > < p > “this year, we propose that by the end of 2020, more than 60% of the secondary and above medical institutions, all the tertiary medical institutions, all the specialized alliances and urban medical consortia should realize mutual recognition of inspection and test results. By the end of 2021, all secondary and above medical institutions will realize mutual recognition of inspection and testing results. ” Guo Yufen said. < / P > < p > in the implementation process, on the premise that the quality of the primary examination results is up to standard, if the higher level hospitals do not recognize the results and other reasons, the higher level hospitals and the responsible doctors shall bear the corresponding expenses; if the quality of the primary inspection results is not up to the standard, the first diagnosis hospital, the diagnosis physician, the relevant professional quality control center, and the assistance Hospital of the first diagnosis hospital shall undertake the corresponding inspection Check the cost. At present, Gansu provincial clinical quality control center, provincial ultrasound quality control center and provincial image quality control center are carrying out relevant technical training. Guo Yufen said: “after the assessment and certification, we should realize the mutual recognition of inspection results. If the results are no problem and the hospital still allows repeated inspection, then we will catch and punish one group. This is also the key work of the Health Supervision Bureau in the future. We hope to use this way to force the grass-roots ability to improve. ” < / P > < p > the construction of telemedicine information platform also brings dividends to the local community. “90% of the common diseases in county-level hospitals have been online, and% of the serious diseases have been basically treated online.” Guo Yufen introduced that the province has integrated the remote consultation system of provincial medical institutions and some cities and prefectures to build a provincial telemedicine information platform with unified dispatching, interconnection and information sharing. At present, the province’s remote consultation system has access to 3710 medical institutions, realizing the full coverage of telemedicine information platform for medical institutions above the township level; 7020 cases of remote consultation, 3427 cases of remote imaging, 986 times of remote training, and 151000 person times of training have been carried out. < / P > < p > “in the past, the introduction of talents in county hospitals required administrative approval at all levels, and doctors who wanted to take root in the grass-roots level were often blocked out.” Guo Yufen said that the channels for talent introduction are now unblocked. Last year, the Organization Department of Gansu provincial Party committee, the editorial office of the provincial Party committee, the Department of human resources and social security and the Health Commission jointly issued the notice on strengthening and improving the introduction of health talents in Gansu Province. It is clear in the document that all localities should implement the autonomy of medical units in employing personnel, and actively promote medical and health units at all levels in cities and counties to implement the record system and commitment system for open recruitment; medical and health units can independently formulate, publish and adjust talent introduction plans within the scope of policies, and independently set the qualification conditions and investigation procedures of introduced talents. This year, Gansu Province proposed to introduce 5-10 talents with bachelor degree or above in clinical medicine in county hospitals of Gansu Province. The first batch of 150 industry backbone talents and 150 outstanding young talents are selected and established in the province for long-term training. Preferential policies are given to the selected personnel, such as preferential arrangement of overseas study, priority of recommendation and evaluation, priority of application of project topics and priority of funding subsidies, so as to further stimulate the enthusiasm of talents to take root in Longyuan. In terms of medical personnel training in county-level hospitals, Gansu Provincial Health Commission issued a document in 2019, which defined the training contents of all county-level medical personnel, and divided the training contents according to disciplines and specialties. Provincial quality control centers conducted remote training, on-site guidance and assessment for 86 county hospitals in the province. In late May, 30 emergency diseases were online through Gansu telemedicine information platform. From then on, all relevant provincial quality control centers began to rush to each county to carry out on-site training according to the work plan. < / P > < p > “at present, there are 10000 people on the line. The assessment will be ready at the end of the year. We require all localities to take the assessment results of medical staff as an important basis for internal recommendation, excellence evaluation and year-end assessment of professional titles. ” Guo Yufen said.