(August 9, 2024)
JDPG GO G [2024] No.5
Attention: all District People's Government Commissions, Offices, Bureaus, Sub-district Offices and Pengpu Township People’s Government:
Implementation Opinions on Improving the “Five-bed Coordinated Operation” to Further Promote the Medical Care/Wellness Care Integrative Development of the Elderly Care Institutions in Jing’an District formulated by the District Civil Affairs Bureau were adopted at the 102nd Routine Meeting of the District People’s Government, and are hereby issued to you for implementation.
Implementation Opinions on Improving the “Five-bed Coordinated Operation” to Further Promote the Medical Care/Wellness Care Integrative Development of the Elderly Care Institutions in Jing’an District
With a view to improving the medical care/wellness care integrative care/nursing service mode featuring the “coordinated operation among five types of beds” (hereinafter referred to as the “five-bed coordinated operation”), and to further refining the elderly care service system characterized by coordination between home services and community institutions and by medical care/wellness care integration, so as to better satisfy elderly people’s needs for medical care/wellness care, and in accordance with the guiding principles of the Regulations of Shanghai Municipality on Elderly Care Service, the Notice on Issuing the Measures for Further Improving the Medical Care/Wellness Care Integrative Development of the Elderly Care Institutions in This Municipality (SMCAB D [2024] No.5) and other documents, the following Implementation Opinions are hereby put forward.
I. Overall Requirements
(I) Guiding philosophy
Adhering to the guidance by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implementing the guiding principles of the 20th National Congress of the Communist Party of China (CPC), and putting into practice the guiding principles from General Secretary Xi Jinping's major speech during his inspection in Shanghai, Jing’an District will take the protection of elderly people’s health rights and interests and the service to satisfy their health care needs as its ultimate objectives. On the basis of the results of the experiments with the “five-bed coordinated operation”, the District will attach importance to the home services/community institutions coordination, and keep enhancing the capabilities of medical and health services to support elderly health care, so as to advance high quality medical care/wellness care integrative development of this District.
(II) Basic principles
1. Guarantee of basic needs and increase of supplies. While the guarantee of the elderly people’s needs for basic health care is prioritized, the supply-side structural reform of the health service for elderly people will be boosted, to increase rehabilitation care supply and better meet elderly people’s demand for diversified medical care/wellness care.
2. Leadership by the government and participation by multiple market players. The “five-bed coordinated operation” will be adopted as an important measure for promoting medical care/wellness care high-quality development in the District so as to foster a work pattern of synergetic advancement and deep integration, and stimulate the enthusiasm of various social entities to participate.
3. Innovative development and technology empowerment. By upholding a problem-oriented and people-centered approach, and exploring and innovating, the District will actively resolve the contradictions and problems encountered in the course of medical care/wellness care integrative development. The resources of various government departments and social entities will be coordinated, and the role of modern information technology will be fully leveraged, in order to drive the integrative development of medical care/wellness care resources and services, improve the quality and raise the efficiency.
(III) Work objectives
Jing’an District will continuously advance the medical care/wellness care integrative care/nursing service mode featuring the “five-bed coordinated operation”. In the District, the medical care/wellness care integration system and mechanisms will be further improved, the medical care/wellness care integrative service network will be refined, the service of “five types of beds” (home-based elderly care beds, elderly care institution beds, home-based medical beds, medical institution beds, and terminal care (palliative care) beds) will be optimized, and a development pattern of orderly sharing and overall integration of the medical care and elderly care resources will take shape on the whole, so that standardized, diversified and sustainable development of medical care/wellness care integrative service will be basically achieved in the District.
II. Main Tasks
(I) Refining the medical care/wellness care integrative service network
1. Improving the contract cooperation mechanism between medical institutions and elderly care institutions. According to the principle of “whoever is willing can sign the contract to ensure basic care”, elderly care institutions are encouraged to sign cooperative contracts with medical institutions such as community health service centers and regional medical centers. Medical institutions may sign differentiated cooperative contracts with elderly care institutions according to the medical institutions’ positioning and on the principle of “advantage complementarity, clearly-defined powers and responsibilities, mutual benefits, pragmatism, high efficiency, and long-term collaboration”. Elderly care institutions with appropriate conditions are encouraged to increase their medical care/wellness care service by purchasing service.
2. Optimizing the layout of service facilities. Community health service centers with the necessary conditions are encouraged to establish, according to laws and regulations, community health service stations and family doctor work rooms within or near elderly care institutions with the feasible conditions so as to provide “inserted” internal medical services. Community health service centers with appropriate conditions are encouraged to conduct cooperative operation with elderly care institutions.
3. Supporting the establishment of internal medical institutions within elderly care institutions with appropriate conditions. Where an elderly care institution applies to establish an outpatient department, clinic, medical room, health room, or nursing station, only the filing administration is required. The elderly care institution may remodel a community health service station or family doctor work room into an internal medical institution according to relevant standards, and entrust the community health service center to operate it.
(II) Upgrading the medical care/wellness care integrative service capabilities
1. Effectively upgrading the medical care/wellness care service capabilities of elderly care institutions. Elderly care institutions and medical institutions they cooperate with are encouraged to set up medical care/wellness care integrative management teams, and, on the basis of refined health assessment, they will jointly provide the residents of elderly care institution with diversified and targeted services such as health education, preventive heathcare, traditional Chinese medicine service, disease treatment, rehabilitation care, long-term care and nursing, and terminal care. Elderly people on home-based elderly-care beds are supported to share the relevant medical services and facilities in elderly care institutions.
2. Improving the “bed transfer” service. Evaluation of the establishment and transfer of beds including home-based elderly care beds, elderly care institution beds, home-based medical beds, medical institution beds, and terminal care beds will be further standardized, and priority will be given to transfers to the designated institutions and to emergency and first-aid green channel services. When the care environment of an elderly person worsens, the elderly care institution shall open a green channel to prioritize him for a home-based elderly care bed or an elderly care institution bed. When the health of an elderly person on a home-based elderly care bed or an elderly care institution bed deteriorates, the elderly care institution shall promptly communicate with a “five-bed coordinated operation” contract member unit to transfer his health records, open the corresponding green channel, and set up a home-based medical bed or transfer him to a medical institution bed. When an elderly person’s health has improved, he may return to the home-based elderly care bed or the elderly care institution bed through the green channel. When an elderly person needs terminal care, he has the priority to be transferred to a terminal care bed to receive end-of-life comfort care.
3. Reinforcing the community/home medical care/wellness care integrative service. Family doctors will sign contracts with more elderly people on home-based elderly care beds and elderly care institution beds, and provide targeted health management for the elderly people under contract. Relying on the community health service center and taking family doctors as the mainstay, integrative health services characterized by “combination of treatment and prevention” and “combination of general practitioners and specialists” will be provided. For elderly people with needs, services such as home-based medical beds, nursing plans, and home nursing are offered, so as to promote the integration of home-based elderly care beds and home-based medical beds.
(III) More powerful support for medical care/wellness care integrative operation
1. Strengthening policy support for elderly care institutions’ medical care/wellness care integrative service. The relevant policies embodied in the Implementation Measures of Shanghai Municipality for “Replacement of Subsidies by Awards” for Elderly Care Institutions shall be carried out. In the case of elderly care institutions that actively conduct the “five-bed coordinated operation”, and have a wide scope of services, a complete range of service items, and good service quality, their operation will be guaranteed and supported in line with the guidelines of the relevant municipal documents.
2. Upgrading elderly care institution employees’ professional levels. Through training programs on medical care/wellness care integration and geriatrics, the community health service centers provide the contracted elderly care institutions’ medical workers with opportunities for free continuing medical education and clinical practice, and periodically offer them homogeneous training in medical services to maintain uniform standards.
3. Creating a system of performance assessment and incentives. Rational performance assessment indicators will be designed, the medical teams engaged in the “five-bed coordinated operation” will receive periodical assessments, the service number, service quality and client satisfaction will be incorporated into the assessment system, and incentive measures such as performance reward and career advancement will be adopted to enhance the teams’ enthusiasm and efficiency. A long-term cooperation mechanism between elderly care institutions and medical institutions will be established, which clarifies the service items, cost sharing, and responsibility assignment.
4. Strengthening support for basic medical insurance. The medical institutions established by elderly care institutions with appropriate conditions are supported to become medical-insurance designated institutions and enjoy, according to provisions, the same medical insurance networking and settlement.
5. Refining the evaluation system and assessment standards. The evaluation system and assessment standards of holistic health science and sociology related to the “five-bed coordinated operation” will be continuously improved though using information technology to collect data and relying on the resources of universities and the industry association. Supervisory expert teams on hygiene, nursing, hospital-acquired infection, elderly care services, clerical work and information shall be formed to jointly clarify service scopes, clearly define responsibilities and promote resource integration and sharing.
6. Improving risk prevention and conflict mediation in the“five-bed coordinated operation” service mode. On the basis of liability insurance of elderly care institutions, the content of risk prevention in medical care/wellness care integration will be added. By relying on the district-level agency for dispute mediation in elderly care service and the relevant working mechanism, timely mediation will be conducted to resolve disputes arising from the “five-bed coordinated operation” service.
(IV) Stronger digital empowerment of medical care/wellness care integration
1. Advancing smart medical care/wellness care. The “five-bed coordinated operation” smart elderly care platform will be used to increase health and elderly-care data sharing, and promote standardized management and practical application of the electronic health records of the residents of elderly care institutions. Explorations will be made to integrate the medical care/wellness care data of the relevant municipal and district government departments, and to enhance the network of medical care/wellness care data, with a view to really achieving connectivity of the “five-bed coordinated operation” information, promoting rational utilization of elderly people’s health and care information in various elderly-care scenarios, and providing more convenient medical care/wellness care integrative service for elderly people and their relatives.
2. Raising the digitalization level of elderly care institutions. Proactive explorations will be conducted into the “elderly care institution + Internet hospital” mode. Through an Internet hospital’s cloud clinics, micro clinics and mobile clinics, services such as online consultation, chronic disease follow-up, follow-up visit for prescription renewal, and drug delivery will be provided to residents of elderly care institutions. Continuous advances will be made in the building of smart elderly care institutions, where whole-process, full-chain and all-time applications will be implemented in many smart elderly care scenarios, providing residents of elderly care institutions with convenient and rapid care service.
III. Responsibilities of Government Departments
The District Civil Affairs Bureau: It is responsible for leading the advancement of the various tasks related to the “five-bed coordinated operation”, and improving the elderly care service system featuring home services/community institutions coordination and medical care/wellness care integration, so as to properly push forward the high-quality development of medical care/wellness care integration.
The District Health Commission: It shall guide the community health service centers and regional medical centers to provide services according to the list of the “five-bed coordinated operation” services, be responsible for the performance assessment and supervisory administration of medical institutions, and contribute to promoting the construction of the “five-bed coordinated operation” smart elderly care platform and the sharing of data resources.
The District Healthcare Security Administration: It shall support the medical insurance settlement for community health service stations and elderly care institutions, conduct supervision over medical insurance and administration of contracts, and contribute to promoting the construction of the “five-bed coordinated operation” smart elderly care platform and the sharing of data resources.
The District Statistics Bureau: It shall contribute to promoting the construction of the “five-bed coordinated operation” smart elderly care platform and the sharing of data resources.
All Sub-districts（townships）: They shall guide the sub-district-level and township-level elderly care institutions to conduct work related to the “five-bed coordinated operation”, and guide and coordinate the local elderly care institutions and community health service centers to jointly advance the integration of home-based elderly care beds and home-based medical beds.
IV. Organization for Implementation
(I) Stronger organization for implementation
The relevant departments shall aim at the objective of aligning with elderly people’s needs for diversified and multi-level health care, strengthen organization and leadership, establish and improve the mechanism of joint action and close coordination of the upper and lower levels, and jointly study and solve the specific problems encountered in the process of advancing the work.
(II) Stricter supervisory administration
The relevant departments shall establish and improve the mechanism of supervising, evaluating and assessing the “five-bed coordinated operation”, tighten oversight of the service quality, and exchange information in a timely fashion, so as to form supervisory synergy; they shall proactively guard against and cope with possible risks, and guide the standardization of the “five-bed coordinated operation” service.
(III) More powerful publicity and guidance
All-dimensional, multi-faceted, and diverse-form publicity campaigns of the “five-bed coordinated operation” shall be carried out to create a congenial atmosphere of full understanding, enthusiastic support and voluntary participation by the whole society, thus constantly increasing the sense of gain and satisfaction of elderly people and their relatives about the “five-bed coordinated operation”.