Advancing the grading diagnosis and treatment system as the main goal and important task of deepening medical reform during the 13th Five-Year Plan period, how to form a new order for the first consultation, two-way referral, rapid division and treatment, and the new medical treatment in the process of advancement. The key issues that the parties are trying to think about and solve. How should medical institutions at all levels perform their functions and functions in their respective roles to provide medical and health services to the masses? Recently, the author interviewed the cardiologists of Peking University People's Hospital and the dean of Beijing Jiaotong University Hospital (Community Hospital) in the same medical association to explore the respective responsibilities of medical institutions at all levels in promoting the grading diagnosis and treatment process.
Large hospital: optimize medical resource allocation and further play a leading role
"Difficult to see a doctor" is reflected in large hospitals, and the well-known top three core hospitals are almost facing high pressures of diagnosis and treatment. Professor Xu Juntang, chief physician of Department of Cardiology, Peking University People's Hospital, believes that the focus of the core top three hospitals should be on the diagnosis and treatment of critically ill and intractable diseases, while taking into account personnel training, research and teaching, and research and development of new technologies. Freed from the diagnosis and treatment of simple diseases and chronic diseases. "A lot of energy is spent on prescribing drugs to patients." Xu Juntang said with a little helplessness that the scarce medical resources of large hospitals should be further optimized.
China has a vast territory and a large difference in economic development levels. Medical resources are scarce and unevenly distributed. Xu Juntang believes that at this stage, it is difficult to have a unified guarantee for the professional ability and level of primary medical institutions, and the prerequisite for achieving graded diagnosis and treatment is to strengthen the medical service capacity at the grassroots level. This is not something that can be achieved overnight.
Xu Juntang takes the first consultation at the grassroots level as an example. It requires simple diseases such as chronic diseases and common diseases to stay in the first consultation at the grassroots level, and it is necessary to refer to the higher level hospital. However, the disease has its complexity. The ability of diagnosis and treatment in primary hospitals is limited and uneven. It may cause problems in the process of judging whether it is a simple disease or a serious condition. This is also the reason why many patients have to go to a large hospital for a small illness: Worried about being misdiagnosed, missed, and delayed by the primary hospital.
"Grading diagnosis and treatment is a result of medical reform, not a policy measure that can be smoothly promoted at this stage. It is necessary to continuously strengthen the ability of diagnosis and treatment at the grassroots level, so that the people willingly stay at the grassroots level." Xu Juntang believes that in order to form a graded diagnosis and treatment Order, almost all of the current planning and design of medical resources and institutional systems, will go through a complex and lengthy process, which requires some transitional policies.
Xu Juntang proposed that while continuously “strong grassrootsâ€, it is necessary to fully allocate existing medical resources. For example, grassroots medical staff such as community doctors can set up a team around the top three hospital experts to diagnose and determine treatment plans and guide grassroots doctors to implement. Form a good connection and division of labor, so that medical resources are in an orderly and highly operational manner.
Taking common cardiovascular diseases such as hypertension and diabetes as an example, patients need long-term management and guidance in lifestyle. When the condition is clear and stable, they should return to the community. “Community hospitals have great advantages in guiding rehabilitation, health education, screening high-risk groups and early intervention.†In addition, Xu Juntang emphasized that as the population ages, the community can unite with the streets and volunteers. The power of all parties and Others will play a greater role in the maintenance of the elderly and the care of the dying.
At the same time, the development of smart medical care, telemedicine and medical informatization has also provided new solutions for promoting graded diagnosis and treatment. Echocardiography is one of the most commonly used and most important examinations in cardiology. Due to differences in equipment and the level of doctors' operations, cardiac ultrasound reports issued by lower-level hospitals are difficult to fully recognize in large hospitals and often require re-examination. The fact is that it is impossible for all community hospitals to establish a comprehensive auxiliary inspection and inspection agency, and there is no need to do so. In addition, community hospitals often force patients to concentrate on large hospitals to prescribe medicines because of incomplete medicines. Large hospitals are overcrowded and overwhelmed, and some community hospitals are at the mercy. Xu Juntang believes that with the help of the Internet and the Internet of Things, these problems can be effectively solved at the technical and operational levels. For example, the centralized laboratory and central pharmacy of the partition film establishment, the community doctors no longer worry about the incomplete inspection equipment and incomplete medicines. There is no fear that the results will not be recognized. Large hospitals and large experts can also be freed from complicated, simple, and mechanical work. They are truly involved in the diagnosis, treatment, teaching, and research work of patients, and truly realize graded diagnosis and treatment. Make effective use of existing medical resources.
"It is necessary to clarify the capabilities and positioning of medical institutions at all levels, to perform their duties and to coordinate with each other to meet the medical health needs of different levels of the people." Xu Juntang said that graded diagnosis and treatment can promote the rational distribution of medical resources, but should be promoted in a reasonable and orderly manner.
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