Policy practice Xin Wang et al People-centred care in urban China (...continued) Core action Implementation Imple- Specific description in the Luohu model Document reference area strategies mented? E-Health Integrated Yes The hospital group designed the Healthy Luohu Luohu government resolution electronic computer application.By logging into their personal n0.24[2015: medical records account,both providers and patients can access Implementation plan for systems electronic health records systems comprehensive reform of public hospitals in Luohu district Communication Yes The Healthy Luohu application allows patients to request and care an online appointment with a specific physician in all management institutions.Staff in community health stations can make functions an online referral for patients to hospitals. The application is also easy for patients to check physician information and update registration and payment forms Interoperability Under Providers in hospitals and community health stations NA of e-health preparation can view patient records in their own institution.Luohu across facilities hospital group is establishing regulations to allow the and services electronic systems to link across institutions securely and effectively Integrated Integrated Under Clinical pathways are being created to standardize the NA clinical clinical pathways preparation treatment and referral pathways between providers pathways and for care dual referral integration and decision support Dual referral Yes In the referral gateway model,patients referred from Luohu government resolution pathways within community health stations are expected to receive no.24[2015: integrated care expedited care in the district-level hospitals. Implementation plan for networks Down-referral,which allows referrals of patients from comprehensive reform of hospital to community health stations for rehabilitation public hospitals in Luohu care or follow-up,is incentivized by a new health district insurance payment system in the Luohu hospital group Measurement Standardized Yes The Luohu hospital group established a performance Luohu government resolution and feedback performance measurement system and makes annual self-evaluations. no.242015] measurement Indicators focus on measures of capacity-building of Implementation plan for indicators staff at community health stations(e.g.numbers of staff comprehensive reform of working in the community health stations,numbers of public hospitals in Luohu outpatients)and obtaining patients'experiences district Continuous Yes The results are communicated back to stakeholders at all feedback loops levels,early positive results and challenges are identifed to drive quality The hospital group is designing new strategies based on improvement measurement results of the last two years Certification Certification No NA NA criteria for local and national use Targets for No NA NA criteria and use to certify facilities NA:not applicable Core action areas and implementation strategies suggested by the policy report Deepening health reform in China. about 80%of residents in 10 districts Lessons learnt tals.Three reasons have been proposed found that satisfaction with health care for the fragmentation of services in in Luohu district ranked first among all Despite promoting care integration China:(i)fee-for-service payments; 10 districts in Shenzhen city.2 within the hospital group and first point (ii)fragmentation of financing;and The health ministry of China was of contact at community health stations, (iii)more generous health insurance satisfied with the results of the two- the Luohu model provided several les- for inpatient than outpatient services. year preliminary evaluation in Luohu sons to overcome challenges during Other researchers suggested that effec- Recognizing that it was a comprehen- implementation. tive care integration can be achieved sive model adopting and combining Improving collaboration without the need for the formal integra- strategies from other initiatives,the tion of organizations.However,the ministry began introducing the Luohu The first challenge was how to improve establishment of the Luohu hospital model to urban areas nationwide on 1 collaboration between community group created a strategy of integration September 2017. health stations and district-level hospi- across organizations and played a key Bull World Hea/th Organ 2018:96:843-852 doi:http://dx.doi.org/10.2471/BLT.18.214908 847Bull World Health Organ 2018;96:843–852| doi: http://dx.doi.org/10.2471/BLT.18.214908 847 Policy & practice Xin Wang et al. People-centred care in urban China about 80% of residents in 10 districts found that satisfaction with health care in Luohu district ranked first among all 10 districts in Shenzhen city.22 The health ministry of China was satisfied with the results of the two￾year preliminary evaluation in Luohu. Recognizing that it was a comprehen￾sive model adopting and combining strategies from other initiatives, the ministry began introducing the Luohu model to urban areas nationwide on 1 September 2017. Lessons learnt Despite promoting care integration within the hospital group and first point of contact at community health stations, the Luohu model provided several les￾sons to overcome challenges during implementation. Improving collaboration The first challenge was how to improve collaboration between community health stations and district-level hospi￾tals. Three reasons have been proposed for the fragmentation of services in China: (i) fee-for-service payments; (ii) fragmentation of financing; and (iii) more generous health insurance for inpatient than outpatient services.23 Other researchers suggested that effec￾tive care integration can be achieved without the need for the formal integra￾tion of organizations.24–26 However, the establishment of the Luohu hospital group created a strategy of integration across organizations and played a key Core action areaa Implementation strategiesa Imple￾mented? Specific description in the Luohu model Document reference E-Health Integrated electronic medical records systems Yes The hospital group designed the Healthy Luohu computer application. By logging into their personal account, both providers and patients can access electronic health records systems Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district Communication and care management functions Yes The Healthy Luohu application allows patients to request an online appointment with a specific physician in all institutions. Staff in community health stations can make an online referral for patients to hospitals. The application is also easy for patients to check physician information and update registration and payment forms Interoperability of e-health across facilities and services Under preparation Providers in hospitals and community health stations can view patient records in their own institution. Luohu hospital group is establishing regulations to allow the electronic systems to link across institutions securely and effectively NA Integrated clinical pathways and dual referral Integrated clinical pathways for care integration and decision support Under preparation Clinical pathways are being created to standardize the treatment and referral pathways between providers NA Dual referral pathways within integrated care networks Yes In the referral gateway model, patients referred from community health stations are expected to receive expedited care in the district-level hospitals. Down-referral, which allows referrals of patients from hospital to community health stations for rehabilitation care or follow-up, is incentivized by a new health insurance payment system in the Luohu hospital group Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district Measurement and feedback Standardized performance measurement indicators Yes The Luohu hospital group established a performance measurement system and makes annual self-evaluations. Indicators focus on measures of capacity-building of staff at community health stations (e.g. numbers of staff working in the community health stations, numbers of outpatients) and obtaining patients’ experiences Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district Continuous feedback loops to drive quality improvement Yes The results are communicated back to stakeholders at all levels, early positive results and challenges are identified. The hospital group is designing new strategies based on measurement results of the last two years Certification Certification criteria for local and national use No NA NA Targets for criteria and use to certify facilities No NA NA NA: not applicable. a Core action areas and implementation strategies suggested by the policy report Deepening health reform in China. 15 (. . .continued)