Take the medical alliance as the carrier to do a good job in the graded diagnosis and treatment work plan of new coronary pneumonia

According to the website of the National Health Commission on December 7, the comprehensive group of the joint prevention and control mechanism of the State Council to respond to the new coronavirus pneumonia epidemic issued the "Work Plan for the Graded Diagnosis and Treatment of New Coronary Pneumonia with the Medical Alliance as the Carrier"
.

 

Take the medical alliance as the carrier to do a good job in the graded diagnosis and treatment work plan of new coronary pneumonia

 

In order to do a good job in the medical treatment of new crown pneumonia, make every effort to ensure the timely treatment of infected people with high risk of severe disease such as the elderly and underlying diseases, reduce the rate of severe disease and mortality as much as possible, ensure the smooth progress of the treatment of new crown pneumonia, ensure the development of normal medical services, build a more scientific and orderly medical order, and formulate this plan
.

 

1.
Work objectives

 

To adapt to the new situation of epidemic prevention and control and the new characteristics of new coronavirus mutations, in accordance with the principle of "health monitoring, categorical management, linkage between upper and lower levels, and effective treatment", scientifically coordinate regional medical resources, use the grid layout of medical alliances as the carrier, improve the referral mechanism between sub-designated hospitals, designated hospitals, medical alliances and tertiary general hospitals with external cooperation of medical alliances, improve the efficiency and continuity of medical services, and protect people's life safety and health
to the greatest extent.

 

2.
Work content

 

(1) Establish a hierarchical diagnosis and treatment service network
for patients with symptoms related to new coronary pneumonia.
Coordinate existing medical resources, take prefecture-level cities and counties as the basis, and plan several grids covering all permanent residents in the jurisdiction in accordance with the principle of zoning and parceling, and form one medical consortium (including urban medical groups and county medical communities) within each grid, or rely on the existing medical alliance to include all residents in the jurisdiction
.
Scientifically coordinate the spatial layout between sub-designated hospitals, designated hospitals and medical alliances, clarify high-level tertiary hospitals as external collaborating hospitals of medical alliances, establish corresponding referral relationships, smooth two-way referral mechanisms, and realize the primary first diagnosis and orderly referral of patients with fever and other symptoms related to new coronary pneumonia
.

 

(2) Clarify the hierarchical diagnosis and treatment process
.

 

1.
Focus on family doctor contracting services to guide patients for primary consultation
.
Community health service centers and township health centers should carry out health monitoring for special personnel such as the elderly with underlying diseases in their jurisdiction, find out the bottom number in advance, implement hierarchical health management according to the level of health risk (see annex), and carry out graded identification with green (low-risk general population), yellow (medium-risk sub-key population), and red (high-risk key population), and carry out special management
of personnel whose health files are yellow and red.
Local administrative departments of health shall designate counterparts in medical establishments to be responsible for health monitoring of the elderly in nursing homes, welfare homes, and other institutions, to ensure full coverage of health monitoring for high-risk groups
.
It is necessary to increase the coverage of family doctor contracted services, establish accounts for family doctor contracted service groups such as children aged 0-6 years old, pregnant women, elderly people over 65 years old, and patients with underlying diseases in the jurisdiction, strengthen the quality of performance, enrich the connotation of contracted services, and include health monitoring of special persons such as elderly people with underlying diseases into the scope of
family doctor contracting services.
Through a letter, a letter, a letter of notification, a hotline and a new media network, the contact information of primary medical and health institutions or medical staff is notified to each key group to ensure that they can be contacted
in a timely manner when necessary.

 

When a patient is found to have symptoms related to new coronary pneumonia, the family doctor should guide the patient to the community health service center or the fever clinic (outpatient) of the township health center contracted for treatment; If the patient's condition exceeds the diagnosis and treatment capacity of the primary medical and health institution, he or she shall be promptly referred to a medical institution with corresponding diagnosis and treatment capacity under the guidance of the lead hospital of the medical
consortium.

 

2.
Strengthen the graded classification of patients infected with the new coronavirus for medical referral
.
Primary medical and health institutions should promptly guide key groups with symptoms related to new coronary pneumonia to conduct antigen testing, and if the antigen test is positive, promptly manage and refer them in accordance with the following grading principles:

 

(1) Asymptomatic infections and mild cases without serious underlying diseases shall be isolated at home or self-care at home, and oral medication treatment shall be given when necessary, and their health status
shall be closely monitored.
For the elderly with mobility difficulties, when the condition permits, in principle, home or on-site treatment in nursing institutions, medical staff provide door-to-door services, and do not transfer out for centralized treatment
.

 

(2) Common cases, elderly people with serious underlying diseases (heart disease, tumors, etc.
) but stable asymptomatic infections and mild cases will be referred to the corresponding sub-designated hospitals of the medical alliance for treatment
.

 

(3) Severe and critical cases with new coronary pneumonia as the main manifestation and cases requiring hemodialysis shall be referred to the designated hospitals corresponding to the medical alliance for centralized treatment, among which critical cases are admitted to ICU wards, severe cases are admitted to sub-ICU wards, and cases requiring hemodialysis are admitted to general wards
.

 

(4) Severe or critical cases with underlying diseases as the mainstay, as well as underlying diseases that exceed the medical treatment capacity of primary medical and health institutions or sub-designated hospitals, shall be referred to the lead hospital of the medical consortium for treatment, and if the lead hospital is not a tertiary general hospital or the capacity does not meet the treatment needs of patients, it shall be referred to a tertiary hospital
that has established a cooperative relationship with the medical alliance.

 

Medical institutions should strictly implement the responsibility system for the first diagnosis and the emergency and critical illness rescue system, and must not shirk or refuse treatment for people infected with the new coronavirus for any reason
.

 

(3) Improve the ability
to deal with new coronary pneumonia.

 

1.
Improve the service capacity
of primary medical and health institutions.
Qualified community health service centers or township health centers should set up fever consultation rooms (outpatient clinics), and fever clinics should have personnel with medical practitioner qualifications, improve the corresponding equipment and drug configuration such as disinfection, inspection and testing, emergency rescue, etc.
, and have the functions
of pre-examination, triage and screening.
Expand the team of primary medical and health personnel through multiple channels, and attract retired medical staff from medical institutions to practice
in primary medical institutions.
Give full play to the supporting role of hospitals above the second level in the medical association, and send doctors and hospital sense management personnel with respiratory, infection, traditional Chinese medicine and other related specialties to community health service centers or township health centers within the medical association, and station them for diagnosis and guidance
.
Those who have not joined the medical consortium shall be designated by the local county-level health administrative department to designate a secondary level or above medical institution to send relevant personnel to provide on-site services
.
At the same time, improve the ability
of grassroots doctors to identify, diagnose and deal with high-risk groups through telemedicine and other means.
All localities should refer to the ninth edition of the diagnosis and treatment plan, and allocate enough traditional Chinese medicine and antigen detection kits
according to 15-20% of the population served.

 

Where conditions permit, special personnel such as the elderly with underlying diseases and those in home isolation may be guided to do a good job in self-health monitoring, antigen self-testing and abnormal reports, collect nucleic acid for those with abnormal antigens, and contact referrals for assistance in need of medical treatment
.

 

2.
Improve the treatment capacity
of new crown pneumonia patients in the leading hospitals of the medical alliance.
Accelerate the construction of ICU wards, buffer wards and convertible ICU beds, with one ICU bed equipped with one doctor and 2.
5-3 nurses as front-line medical staff, and reserve reserve forces
according to 20-30% of the total number of front-line medical personnel.
Establish a mixed grouping model
composed of medical staff specializing in critical care medicine and trained medical personnel from other specialties.
It is necessary to strengthen training and improve the ability
of relevant medical personnel to treat serious diseases.

 

(4) Do a good job in the configuration and dispatch
of transfer vehicles.
All cities and counties shall scientifically allocate transfer vehicles
according to the grid population and medical resource allocation based on the grid layout of medical alliances.
Strengthen the overall planning and dispatch of cities and counties to ensure the timely transportation
of high-risk groups of new coronary pneumonia in the grid.

 

(5) Do a good job of patient referral and connection
.
Medical institutions such as designated hospitals, sub-designated hospitals, and leading hospitals of medical alliances should designate special personnel to be responsible for making referrals and connections with primary medical and health institutions, transfer vehicles
, etc.
It is necessary to establish a clear reception process and green channels, especially tertiary hospitals should specially open green channels for high-risk groups to receive treatment, and must not delay, shirk, or refuse to accept high-risk patients
referred by primary medical and health institutions.

 

(6) Give full play to the supporting role
of informatization.

 

1.
With the medical alliance as the standard, realize the full coverage of telemedicine in the fever consultation room (outpatient) of the community health service center or township health center, and improve the primary diagnosis capacity
of the grassroots level in higher-level hospitals through remote consultation, remote diagnosis, remote training, etc.

 

2.
Strengthen the interconnection of outpatient electronic medical records of medical institutions in the medical alliance, and promote orderly two-way referral.

 

3.
Relying on information platforms such as national health information platforms at all levels and hierarchical diagnosis and treatment referral platforms, promote information interconnection between medical alliances, medical alliances and designated hospitals and sub-designated hospitals, and medical alliances and external collaborating hospitals, to ensure timely diagnosis, timely transfer, and timely treatment
of patients in need of treatment.

 

4.
Give full play to the positive role of Internet medical services in convenience and efficiency, use Internet hospitals, Internet diagnosis and treatment platforms, official new media platforms and other information platforms and technical means to actively carry out online health assessment, home health guidance, health education, and psychological counseling, provide Internet diagnosis and treatment and offline drug delivery services, and timely guide patients with changes in their condition to competent medical institutions
.

 

3.
Organization and implementation

 

(1) Strengthen organizational leadership
.
Local health administrative departments should improve the grid layout of medical alliances in their jurisdictions by December 20, 2022, ensure full coverage of high-risk groups of new coronary pneumonia, and coordinate relevant departments to provide financial guarantees
for health monitoring of high-risk groups.
At the same time, it is necessary to guide and urge all fever clinics (outpatient clinics) in qualified primary medical and health institutions to open before December 20, and complete traditional Chinese medicine and antigen detection reagents
.
Establish a special referral class, clarify the two-way referral workflow between all levels and types of medical institutions, and coordinate the transfer of
patients in the process of graded diagnosis and treatment.

 

(2) Refine the implementation plan
.
All provincial-level health administrative departments should formulate and complete the implementation plan before December 15, 2022, guide the health administrative departments at all levels and all medical and health institutions in the jurisdiction to prepare for the first diagnosis at the grassroots level, determine the graded diagnosis and treatment process of new coronary pneumonia, and report the implementation plan to the National Health Commission
.

 

(3) Do a good job of supervision and guidance
.
Local health administrative departments have adopted a variety of methods to strengthen the training of medical staff, focusing on training personnel in new coronary pneumonia-related symptom recognition, antigen testing, health monitoring, and referral procedures for personnel of primary medical and health institutions
.
It is necessary to guide the lead hospitals of the medical alliance and other tertiary hospitals to prepare for severe treatment, urge the leading hospitals to implement the guidance responsibility for medical treatment, health monitoring and infection prevention and control of primary medical and health institutions, send medical staff and infection control personnel to station guidance, and continuously improve the ability
of primary medical and health institutions to detect and deal with infected persons.
The National Health Commission will supervise and guide
the implementation in various localities.

 

(4) Strengthen publicity and guidance
.
Strengthen publicity on the improvement of primary medical and health service capacity and the arrangement of graded diagnosis and treatment, enhance the people's awareness and recognition of the graded diagnosis and treatment of new coronary pneumonia, establish the concept of scientific medical treatment, and promote the formation of an orderly medical treatment pattern
.