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Policy practice Xin Wang et al People-centred care in urban China priorities,patient goals and care plans, records in their own system.With the review their personal performance and and approve test orders,medication and help of a Chinese internet company identify problems which are then used referrals. Luohu hospital group designed a new to drive continuous improvement. Third,the Luohu hospital group computer application called Healthy comprises 29 institutions at the com- Luohu,which all health-care providers Preliminary evaluation munity and district levels.In this vertical can access.Patients too can access their According to the annual self-evalu network,district-level hospitals focus on own medical records online. ations of the Luohu hospital group, providing complex care and emergency Sixth,there is a referral gateway 575012 residents (around 39%of the care for life-threatening situations. between community health stations population)had signed contracts with Community health stations provide and hospitals in the group.Patients primary health-care teams by July 2017 health promotion,preventive care,case can be referred from community From June 2015 to June 2017 increasing management and medical care for com- health stations to hospitals for expe- proportions of the population used ser- mon diseases dited care or can be referred back from vices in the Luohu hospital group rather Fourth,multidisciplinary primary hospitals for continuous rehabilitation than other hospitals outside the group health-care teams help to integrate dif- care and follow-up within primary after establishment of the integrated ferent types of care.Health promotion care.Patients referred via the gateway care programmes(Fig.2).Increasing staff was recruited from the former fam do not need to go through the hospital number of patients with diabetes,hy ily planning stations to provide health patient registration process and are pertension and severe mental illness are education for patients.Public health given priority for care in the hospital now under integrated case management physicians working at the Chinese Cen compared with those directly access- (Fig.3),which reflects greater collabo- ter for Disease Control and Prevention ing the hospital. ration between district-level hospitals provide services such as,responding to Seventh,the Luohu hospital group and community health stations.From and reporting infectious diseases and established a performance measure- 2015 to 2017 the administration ex- public health emergencies and monitor- ment system.The general manage- penses of the whole group reduced by ing domestic water supplies. ment centre is responsible for making 19%(from US$30.0 million to US$ Fifth,hospitals and community annual evaluations of performance 24.3 million),and the average salary health stations previously used two dif- using data collected by the informa- of staff in community health stations ferent electronic information systems tion centre (Fig.1).The results are increased by 10%(from US$26915 to and providers could only view patient communicated back to stakeholders to USS 29 607).Furthermore,a survey of Table 1.Core actions and strategies to achieve people-centred integrated care in Luohu district,Shenzhen city,China Core action Implementation Imple- Specfic description in the Luohu model Document reference area strategies mented? Primary care as Patient Yes Residents in Luohu district are encouraged to sign a Luohu government resolution first contact registration contract with a general practitioner voluntarily.The n0.24[2015: agreement defines a package of services,the service Implementation plan for delivery process,and the rights and obligations of both comprehensive reform of patient and provider. public hospitals in Luohu Contract period is one year with a specific general district practitioner.At the end of the period the patient can sign a contract with another general practitioner,which allows some element of patient choice. Risk stratification Under Previous electronic information systems could not NA preparation support risk stratification.Luohu hospital group is preparing to collect data for a risk stratification exercise based on disease burden,using a new computer application program. Gatekeeping Yes Patients are strongly encouraged to see their primary Luohu government resolution health-care provider before a visiting a hospital no.24[2015]: specialist.However,they are not formally required to do Implementation plan for 50. comprehensive reform of To promote patients'use of family medical practices as public hospitals in Luohu the first contact,district-level hospitals assign specialists district to work temporarily in community health stations. Ensuring e Home visits are provided for patients who sign a contract National Health and Family accessibility with a general practitioner,especially for the elderly Planning Commission of people. Luohu district resolution no 672015]: Implementation plan for home visits in Luohu district (continues...) Bull World Hea/th Organ 2018,96:843-852 doi:http://dx.doi.org/10.2471/BLT.18.214908 845Bull World Health Organ 2018;96:843–852| doi: http://dx.doi.org/10.2471/BLT.18.214908 845 Policy & practice Xin Wang et al. People-centred care in urban China priorities, patient goals and care plans, and approve test orders, medication and referrals. Third, the Luohu hospital group comprises 29 institutions at the com￾munity and district levels. In this vertical network, district-level hospitals focus on providing complex care and emergency care for life-threatening situations. Community health stations provide health promotion, preventive care, case management and medical care for com￾mon diseases. Fourth, multidisciplinary primary health-care teams help to integrate dif￾ferent types of care. Health promotion staff was recruited from the former fam￾ily planning stations to provide health education for patients. Public health physicians working at the Chinese Cen￾ter for Disease Control and Prevention provide services such as, responding to and reporting infectious diseases and public health emergencies and monitor￾ing domestic water supplies. Fifth, hospitals and community health stations previously used two dif￾ferent electronic information systems and providers could only view patient records in their own system. With the help of a Chinese internet company, Luohu hospital group designed a new computer application called Healthy Luohu, which all health-care providers can access. Patients too can access their own medical records online. Sixth, there is a referral gateway between community health stations and hospitals in the group. Patients can be referred from community health stations to hospitals for expe￾dited care or can be referred back from hospitals for continuous rehabilitation care and follow-up within primary care. Patients referred via the gateway do not need to go through the hospital patient registration process and are given priority for care in the hospital compared with those directly access￾ing the hospital. Seventh, the Luohu hospital group established a performance measure￾ment system. The general manage￾ment centre is responsible for making annual evaluations of performance using data collected by the informa￾tion centre (Fig. 1). The results are communicated back to stakeholders to review their personal performance and identify problems which are then used to drive continuous improvement. Preliminary evaluation According to the annual self-evalu￾ations of the Luohu hospital group, 575 012 residents (around 39% of the population) had signed contracts with primary health-care teams by July 2017. From June 2015 to June 2017 increasing proportions of the population used ser￾vices in the Luohu hospital group rather than other hospitals outside the group after establishment of the integrated care programmes (Fig. 2). Increasing number of patients with diabetes, hy￾pertension and severe mental illness are now under integrated case management (Fig. 3), which reflects greater collabo￾ration between district-level hospitals and community health stations. From 2015 to 2017 the administration ex￾penses of the whole group reduced by 19% (from US$ 30.0 million to US$ 24.3 million), and the average salary of staff in community health stations increased by 10% (from US$ 26 915 to US$ 29 607). Furthermore, a survey of Table 1. Core actions and strategies to achieve people-centred integrated care in Luohu district, Shenzhen city, China Core action areaa Implementation strategiesa Imple￾mented? Specific description in the Luohu model Document reference Primary care as first contact Patient registration Yes Residents in Luohu district are encouraged to sign a contract with a general practitioner voluntarily. The agreement defines a package of services, the service delivery process, and the rights and obligations of both patient and provider. Contract period is one year with a specific general practitioner. At the end of the period the patient can sign a contract with another general practitioner, which allows some element of patient choice. Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district Risk stratification Under preparation Previous electronic information systems could not support risk stratification. Luohu hospital group is preparing to collect data for a risk stratification exercise based on disease burden, using a new computer application program. NA Gatekeeping Yes Patients are strongly encouraged to see their primary health-care provider before a visiting a hospital specialist. However, they are not formally required to do so. To promote patients’ use of family medical practices as the first contact, district-level hospitals assign specialists to work temporarily in community health stations. Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district Ensuring accessibility Yes Home visits are provided for patients who sign a contract with a general practitioner, especially for the elderly people. National Health and Family Planning Commission of Luohu district resolution no. 67 [2015]: Implementation plan for home visits in Luohu district (continues. . .)
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