How to determine the service target and key population of the family doctor contract?
The focus of the family doctor contracting service in 2018 is to do a good job in performing services for the contracted population, stabilize the number of contracts, consolidate the coverage of the contract, and do not blindly pursue and improve the contracting rate of the crowd.
Given the existing capabilities of primary-level medical and health institutions, continue to give priority to signing services for key people. Signing services for poor people and special family planning families with willingness to sign must be signed as required; in accordance with the “Shandong Province Work Plan for the Establishment of a National Demonstration Province for the Integration of Medical and Nursing in Shandong Province” (Lu Zheng Ban Zi (2018) No. 28 ), The coverage rate of the elderly household contract service in 2018 strives to reach more than 70%.
How to set up a family doctor service team? What are the requirements for the number of services?
The family doctor service team must meet the relevant requirements of the “Guidelines for Shandong Family Doctor Contract Service (Trial)”. The service team is mainly composed of family doctors (general practitioners, practicing (assistant) doctors in township health centers and community health service institutions, rural doctors who have obtained the qualifications of practicing (assistant) doctors, and retired clinicians in public hospitals), nurses, and public health practitioners (assistants) ) The composition of physicians should ensure that each team has a general practitioner or clinician with a qualified (assistant) qualification. Each county (city, district) health and family planning administrative department should do a good job in the review and control of team formation, establish a family doctor service team personnel file database, and provide basic data support for strengthening team management, conducting targeted training, and implementing appointment number authority. .
The number of residents signed by each family doctor service team shall not exceed 2,000 in principle. If the proportion of the contracted residents constitutes a higher proportion of the key population such as the elderly or the service packages signed by the residents are more, the number of contracted residents should be appropriately reduced according to the team's service capabilities to ensure the quality of the contracted service.
What are the requirements for the signing process?
The following points should be grasped in the signing process. One is to carefully design the content of the service package. According to the principle of "combining basic medical treatment, public health and health management, combining disease monitoring with complication monitoring and risk assessment", the service package content should be designed to avoid problems such as overly general service content and excessive focus on inspection items. The second is to ensure that residents have informed consent and self-signed contracts. Signing should be done face to face. Before signing a contract with a resident, face the introduction of the meaning of the family doctor contract service to the residents, the local contract service policy, the professional and expertise of the family doctor service team members, and introduce the optional service packages to the residents based on the health status and needs of the residents The content and its charging standards enable residents to choose to sign contracts on the premise of full understanding. The third is to obtain residents' health information management authority when signing the contract. The signing agreement should include the terms "grant the family doctor service team the right to read, use and manage the health information of the contracted residents at all levels and types of medical and health institutions" and other aspects, and make an explanation to the residents and obtain the consent of the contracted residents In order to carry out health management of contracted residents. In areas with good information support conditions, the service team and service package can be selected through the network first, and then the face-to-face contract can be signed. Fourth, the signing process should be linked to the signing of contracts by local medical insurance designated primary-level medical and health institutions. The contract period is in principle one year, and localities can adjust the contract period of the first year appropriately according to the contract time limit of the primary medical and health institutions designated by the medical insurance, so as to realize the payment of the family doctor contract and the basic medical insurance on the service time limit, contract procedure and fee collection Connect with fixed-point signing.
What links must be put in place to fulfill the contract? How can residents of different health conditions provide targeted services?
One is to develop a health management plan. After completing the residents' contract, the family doctor service team should formulate health management plans one by one under the guidance of specialists in hospitals at or above the second level, and clarify the management objectives, measures, frequency and standards. The second is to refine service requirements. According to the health management plan, formulate a service schedule, clarify the responsible person in the team, and make good communication for the contracted residents. The third is to provide paper or electronic service manuals. To integrate the health management plan, service content, service schedule, and responsible persons in the team to form a contracted service paper or electronic service manual, which will be provided to contracted residents so that residents can query their health management plan, service package content, and service time in a timely manner You can contact the family doctor in time if you need it and the service status.
For contracted residents of different health conditions, the content of contracted services is also different. For healthy people, it mainly provides services such as the establishment of residents' health records, health education, and guidance on the control of health risk factors; for high-risk groups, as well as the elderly, children, pregnant women, and other key groups, it mainly provides personalized guidance on health evaluation and control of health risk factors , Health self-test and health management services; for people suffering from hypertension, diabetes and other diseases, mainly provide disease assessment, health examination, follow-up and rehabilitation guidance. At the same time, combined with the service capacity of the primary medical and health institutions and the needs of contracted residents, it can provide multi-level and diversified services such as remote diagnosis and treatment, wearable device monitoring and so on.
What are the requirements for contracted service yards?
One is to establish a family doctor studio. Primary-level medical and health institutions should transform the layout and process of outpatient clinics in accordance with the needs of contracted services, establish family doctor studios on the basis of full-specialty clinics, form a fixed place for outpatient medical services of family doctor service teams, and realize the targeted distribution of contracted residents Consultation. The second is to coordinate the construction and use of healthy cabins. The grass-roots medical and health institutions should further expand it on the basis of the established health lodges, making it a comprehensive service place integrating functions such as the establishment of residents ’health records, health education, policy publicity, on-site contracting, and residents’ self-service medical examination monitoring. The third is to establish a community family doctor studio. Set up a community family doctor studio in the village clinic, day care center for the elderly, community comprehensive cultural activity center and other places, as a family doctor service team patrol service place, the family doctor service team members carry the sphygmomanometer, blood glucose meter, health Portable devices such as all-in-one machines, fixed one or two half-day fixed-point fixed-point visits every week
How to design a family doctor contract service information system or module?
The county shall deploy and apply a unified primary health and family planning information system to realize the eight basic functions of the "Shandong Province Basic Health and Family Planning Information System Basic Functional Specification", in which family doctor contract service information systems should implement basic public health services and medical services. System interconnection and information sharing, built a service interaction platform for the family doctor service team and contracted residents, a work platform for the family doctor service team, a contracted service work management platform, a support interaction platform for the family doctor service team and higher-level hospitals and other departments to meet Health and family planning administrative departments, primary medical and health institutions, and family doctor service teams are using mobile Internet and smart terminals for contract signing, performance, management, and assessment.
How should hospitals above the second level provide support for family doctors to sign up for service work?
Hospitals above the second level shall set up a specialist service team composed of deputy senior staff of the department of internal medicine, surgery, obstetrics and gynecology, pediatrics, cardiology, endocrinology, neurology, etc. and above, and a family doctor service team at the grassroots institutions within the jurisdiction or the medical union Pairing, participating in the contracting service of patients with complex diseases and difficult diseases by instructing the family doctor service team to formulate a health management plan for contracted residents, regularly sit at the grass-roots institutions, set up a joint clinic for chronic diseases, carry out remote diagnosis and treatment, and receive referrals. County-level maternal and child health institutions, tuberculosis prevention and treatment institutions, tuberculosis treatment designated hospitals, and mental health professional institutions shall form professional teams respectively, and participate in the comprehensive participation of pregnant women, children, tuberculosis patients and patients with severe mental disorders in accordance with the principle of zoning and responsibility to people Signing service.
At the same time, hospitals above the second level should establish a remote diagnosis and treatment network with township hospitals and community health service institutions to achieve full coverage of remote medical treatment at the grassroots level, so that the grassroots level institutions can provide services such as remote consultation and remote case discussion for contracted residents, while increasing the level above the second level. The efficiency of hospital specialists participating in the contracted service.
How to implement two-way referral in family doctor contract service?
Hospitals above the second level shall designate general medicine departments or other departments to connect with family doctors ’contracted services, and provide priority outpatient services, priority large-scale equipment inspection, priority hospitalization, and priority surgery services for contracted patients referred by the primary level. At the same time, speed up the construction of the appointment number source management platform, and open the specialty or expert number sources of hospitals above the second level to family doctors in advance. Before the appointment number source management platform is built, hospitals at and above the second level can facilitate the registration and timely registration of registered residents by placing registration machines in primary-level medical and health institutions.
How to grasp the publicity focus of family doctor contract service at this stage?
One is to publicize the benefits that contracted service work brings to residents. It is necessary to widely publicize the preferential policies for family doctor contracting services to residents, so that residents can fully understand the benefits that contracting services bring to residents. At the same time, it is not possible to make unrealistic promises to residents. It is necessary for residents to fully understand the connotation and standards of contracted services at this stage and to reasonably guide residents' expectations. The second is to publicize the access to contract service and the main service methods. It is necessary to inform the residents that the main place for signing the contract is to sign the contract between the primary medical and health institutions, and the main service method is that the residents go to the primary medical and health institutions to receive services. The third is to publicize the typical contract service work. It is necessary to cultivate and dig out excellent primary-level medical and health institutions, family doctor service teams and family doctor models, and widely publicize them. With the help of the typical propaganda of the work, the correct signing service concept is spread to create a good social atmosphere.
What kind of work should the municipal, county-level health and family planning administrative departments and grass-roots medical and health institutions focus on when signing family doctor contract services?
The "Notice" specifically clarifies the key work carried out by the municipal and county-level health and family planning administrative departments and grass-roots medical and health institutions in recent stages, so as to facilitate the implementation of key work in various places. The municipal health and family planning administrative department is mainly responsible for coordinating relevant departments, clarifying the contracted service fee standards and sources, implementing the medical insurance contracting service guidance policy, and increasing the contracted service price charging items. The county level health and family planning administrative department is mainly responsible for clarifying the formation of the family doctor service team Standards, establish family doctor service team personnel file information database, formulate contracted service assessment and evaluation mechanism and contracted service fee distribution principle, promote the construction of primary health and family planning comprehensive information system, etc .; primary health care institutions are mainly responsible for the establishment of family doctor service team and establishment of team The internal division of labor and collaboration mechanism, the formulation of mid-to-high-level service packages, the transformation of institutional layout and outpatient procedures, and the establishment of a service team monitoring and evaluation mechanism.