Tertiary Level Hospital and Community Health Service

1. Tertiary Level Hospital andCommunity Health Service Jianwen CAO Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University June 5th, 2009

2. Outline1. Basic situation of tertiary level hospital2. Introduction of Hospital Group3. Project 5＋3＋1 of Shanghai Municipal Government4. Referral channel among tertiary level hospital, secondary level hospitals and community health service centers5. Clinicians of tertiary level hospital work in community6. Recommendation

3. 1. Basic situation of tertiary level hospital • According to criteria of hospital classification, tertiary level hospitals mainly focus on complex and serious disease, be responsible for teaching and research. They are regional medical centers. • Near 40 tertiary level hospitals in Shanghai • Affiliated tertiary level hospitals of Fudan University, Shanghai Jiao Tong University, the Second Military Medical University, Tong Ji University, Shanghai Traditional Chinese Medicine University • Tertiary level hospitals of Shanghai Hospital Development Center • Tertiary level hospitals of Army

4. 2. Introduction of Hospital Group • In order to increase health services market share, tertiary level hospitals in Shanghai integrated hospital group. Hospital group has developed near 10 years • Hospital group is leaded by one tertiary level hospital, integrating several secondary level hospitals • Zhongshan, Huashan, Renji, Ruijin, Shanghai Sixth People’s Hospital Group etc. • Hospital groups in Shanghai have covered all Shanghai rural areas and some neighbor provinces and cities

5. 3. Project 5+3+1 of Shanghai Municipal Government • To meet people’s medical demands, in the next few years, 5 tertiary hospitals will be established in Jiading, Baoshan, Nanhui, Pujiang, and Pudong, leaded by Huashan, Renji, Ruijing Changzheng, and Shanghai Sixth People’s Hospital Respectively. • 3 secondary level hospitals will be upgraded to tertiary B level hospitals, including Chongming, Nanhui, Qingpu Central Hospital • 1 tertiary hospital will be relocated, Jinshan Hospital

6. 4. Referral Channel among tertiary level hospital, secondary level hospital and community health service centers • It’s very difficult and expensive to be inpatient of tertiary level hospital. In order to decrease patient’s economic burden and enhance tertiary level hospital’s efficiency, some recovery patients in tertiary level hospital will referral to secondary level hospitals or community health service centers • Regional secondary level hospitals, community health service centers should contract referral with tertiary level hospital, and becoming continued treatment base of tertiary level hospital

7. 4. Referral Channel among tertiary level hospital, secondary level hospital and community health service centers The efficiency of tertiary level hospitals have been increased. ALOS around 10 days, the number of discharged patients and surgical cases increased more than 10%

8. 4. Referral Channel among tertiary level hospital, secondary level hospital and community health centers • Difficulty • It’s very difficult to change patients’ behavior to see doctor. Patients worry about the medical quality of secondary level hospitals or community health service centers. • Some restrictions of commercial health insurance reimbursement. • The beds limitation of community health service centers.

9. 4. Referral Channel among tertiary level hospital, secondary level hospital and community health centers • Solution • Patients who are referred to secondary level hospital or community health service centers can get regular check by clinician from tertiary level hospital • Contract with commercial health insurance companies, if therapy agreed by doctors from tertiary level hospital, and thus the referred patients can be reimbursed • No solution to limits of beds of community health service centers yet

10. 4. Referral Channel among tertiary level hospital, secondary level hospital and community health centers • Chronic disease’ monitor, prevention having been developed in various districts, e.g. high blood pressure, diabetes mellitus, tumor etc. • Chronic disease screen should be developed in secondary level hospital and community health service centers instructed by tertiary level hospital. Patients who need further diagnosis and therapy should be referred to tertiary level hospital, while patients whose condition is stable should be referred to secondary level hospitals or community health service centers to manage the health

11. 5. Clinicians of tertiary level hospital work in community • Clinicians from tertiary level hospitals can do health education in the community, after the education, more and more patients come to tertiary level hospitals to see doctors • Under the instruction of tertiary level hospital, “Diabetes Mellitus Hut”, “Orthopaedic Rehabilitation Base”, “Heart Disease Family” etc. has been established in community.

12. 5. Clinicians of tertiary hospital work in community • Outcomes • Rate of attaining target for DM control increase substantially • Rate of attaining target for HBP control increase substantially • Patients Quality of life increase substantially • Complication of chronic disease is decreasing • ……

13. 6. Recommendation • Shanghai is establishing health information infrastructure based on residents health electronic record in the next few years. • More nursing homes with medical characteristics needed. Aging increase the demands of elder people’s disease, chronic disease. • Strengthen community health service centers, including staff training, necessary infrastructure investment, health education. Enhancing instruction of tertiary level hospitals, Universities, and control chronic disease, improve residents quality of life.

14. THANK YOU!