Hangzhou Xihu District Health Care Training Case settled in Zhejiang hospital "West Lake Model" to promote the pilot construction of Health Care System in Zhejiang Province

The launching ceremony was presided over by Li Jianqun, director of the Civil Affairs Bureau of Xihu District. She introduced that the construction of Health Care System refers to the active construction of an elderly care service system based on home, supported by community, supplemented by institutions and combined with medical care, focusing on the protection of the elderly, disabled, semi-disabled and mentally retarded elderly. On March 27, the Department of Civil Affairs of Zhejiang Province organized and held a research project deployment meeting on "accelerating the construction of Health Care System". Xihu District of Hangzhou became one of the pilot projects of this work, which was carried out in Xixi Street and Sandun Town.

Jin Xiaoqing said that Zhejiang Hospital has been making active exploration in promoting the combination of medical care and maintenance and strengthening aging health services. By strengthening the guidance and cooperation of grass-roots medical and health institutions, promoting the construction of seamless referral system between hospital community family, promoting the healthy aging work and the integrated management of medical care and health, Zhejiang hospital has realized the in-depth combination of "medical care" and "maintenance". In 2017, Zhejiang Hospital signed a contract with the West Lake District government to host the West Lake District Integrated Traditional Chinese and Western Medicine Hospital, established the "West Lake Model", effectively integrated the care resources in the medical institutions and communities, and cooperated with the medical care group and elderly hospitals to create community pension samples, diversified promote the "West Lake Model", so as to make the integration of medical care and health develop in depth. This time, we will actively cooperate with the West Lake District government to help the pilot construction of Health Care System in Zhejiang Province. Zhejiang Hospital will further improve the level of technical service capacity and regional radiation depth of medical care integration, so as to bring more high-quality medical care services to more people.

Start wellness assessment

File more elderly people and re-evaluate them regularly

Grandma Chen, who lives in Sandun Xinhong garden, is 70 years old. This morning, when the medical staff of Zhejiang Hospital went to the evaluation, she happened to be taking care of her wife Uncle Zhou who was paralyzed in bed due to four times of moderate stroke. As soon as she heard that the medical staff of Zhejiang Hospital came, she immediately came out and greeted them excitedly.

The medical staff of Zhejiang Hospital compared the scale and made a comprehensive evaluation from the aspects of medical history, condition, functional status, home environment, pipeline nursing, care pressure, psychological burden and social support. In addition to the nursing related to the replacement of nasogastric tube, the medical staff also conducted a comprehensive physical evaluation and examination for grandma Chen and Uncle Zhou, According to her condition, she was given with the professional disease and drug guidance.

”Enjoying the door-to-door service of the medical staff of the third class a hospital, grandma Chen said gratefully: "thank you very much for such door-to-door home service, which has given us a lot of convenience. In the past, in order to replace the gastric tube, I had to use four people to move the old man downstairs. I had to call 120. In addition to manpower, it would cost more than 300 yuan. Patients have to suffer a lot. When they arrive at the hospital, they have to register, queue up and pay... Now with this service, I save a lot of trouble and feel at ease. "

Jin Xiaoqing introduced that the health assessment like Grandma Chen was launched in early June. At present, more than 300 elderly people have been screened at six assessment points in Xixi Street area, and 30 suspected disabled elderly people have been evaluated. In the near future, Zhejiang hospital will also carry out the assessment of disabled and elderly people for Xixi street and Sandun Town, strive to establish capacity assessment files for 50% of the key elderly people in the two jurisdictions within two months, and re-evaluate them regularly.

Further promote the integrated development of "West Lake Model"

Let people enjoy the rehabilitation experience near home

According to the "9064" pension policy, more than 90% of the elderly choose home-based pension, and the elderly have the characteristics of integration, multiple diseases and coexistence. The "Four Modernizations Superposition" trend of aging, empty nest and disability in Hangzhou is becoming more and more significant. Facing the gradual degradation of physical function, the demand for home-based rehabilitation and elderly care is very strong. However, there are still some problems in the construction of home-based elderly care system, such as unclear referral mechanism, insufficient medical capacity, lack of professionals, incomplete implementation equipment and so on. The diversified elderly care needs of the elderly can not be fully met.

Jin Xiaoqing said that in order to open up the last kilometer of integrated medical and maintenance services, let patients get good care in a warm home, reduce family members running back and forth between hospitals and families, and extend nursing services to home care, the elderly rehabilitation and nursing team of Zhejiang Hospital will provide targeted and personalized home rehabilitation and nursing programs for the elderly within its jurisdiction, Further explore the construction of "hospital community home" elderly health care system and mutual referral mechanism under the core guidance of the hospital, so as to provide basis for the government to issue policies.

After the thorough evaluation, through the sorting and analysis of the evaluation data, the ability stratification standard for the elderly will be formulated, and a preliminary rehabilitation care plan will be formed for different stratification groups, including rehabilitation training plan, long-term medical care plan and long-term life care plan. The service contents include home rehabilitation training, vital signs monitoring, condition observation, personalized nursing service and guidance, psychological comfort, etc. At the same time, the long-term life care for the elderly will be referred to a third party for door-to-door service.

Become "Hangzhou Xihu District Health Training Base"

Zhejiang Hospital will provide long-term rehabilitation mechanism

Taking care of the disabled and mentally retarded elderly requires not only professional nurses, but also family members to have certain nursing knowledge. However, the professional rehabilitation nursing technology of family members and service personnel of the disabled elderly is very lack, and the quality of care is uneven.

Miao Lingrong, Deputy Head of West Lake District, awarded the license to Zhejiang Hospital

"Hangzhou Xihu District Health Training Base"

To this end, Zhejiang Hospital will assist Xihu District government to carry out Rehabilitation Training Projects for family members and service personnel of home-based disabled elderly, and establish and improve the training mechanism of service personnel. Systematic training is carried out from three levels: first, evaluator training, which is mainly aimed at grass-roots hospitals, community medical staff and social workers to improve their comprehensive evaluation ability and home service ability for the elderly; the second is rehabilitation skills training, which aims to improve the rehabilitation skills of grass-roots and community medical staff; the third is the training of family caregivers and nurses, mainly to improve the care skills and abilities of elderly care institutions and family caregivers.

According to statistics, Zhejiang Hospital will provide basic rehabilitation nursing theory and practical knowledge training for family members of at least 200 home disabled elderly and 1,000 service personnel, so as to increase the basic rehabilitation nursing theory and practical knowledge of family members and service personnel of home disabled elderly, so that their family members can have basic rehabilitation nursing ability, It can provide relatively professional family care for the disabled elderly, preserve the residual functions of the disabled elderly to the greatest extent, and improve the quality of life of the disabled elderly. At the same time, Zhejiang Hospital will also provide continuous help and support for the disabled elderly at home, so as to reduce the number of hospitalizations of the disabled elderly, improve the quality of life of the disabled elderly and effectively reduce the expenditure of medical resources.

Jin Xiaoqing said that the construction of Health Care System is an important requirement of the new era, an important measure to make up for the shortcomings of elderly care services, and a key link to improve the quality of life of the elderly. Zhejiang Hospital has high-quality resources and sufficient experience in the construction of Medical Care and Health System, and continues to make breakthroughs in the construction of Health Care Service System, Talent Team Training and Evaluation Standard System. Through more pilot projects, Zhejiang Hospital promotes the construction of the city's Health Care Consortium to really take new steps, so as to lay a more solid foundation for further meeting the aspirations of the elderly for a better life, make the elderly feel richer, more secure and more sustainable.