| China is now in the stage of rapid population aging,and the demand for medical services has reached a new plateau,actually we are in urgent need of a comprehensive elderly medical service system.At present,the domestic elderly medical service system only focuses on the treatment of the disease itself.The general public hospitals at all levels that undertake the main medical tasks in China have strongly felt the capacity limitations,and the problems of endless patients and beds shortage have become increasingly prominent.Most of the elderly population have suffered from various chronic diseases,such as hypertension,diabetes,stroke,heart disease,tumors,psychiatric diseases,etc.The combination of aging and chronic diseases makes people with acute diseases generally have to deal with more clinical,psychosocial and daily life problems,thereby more interventional measures and longer recovery times are needed,which undoubtedly greatly increases the burden on large public hospitals In order to allow more patients to enjoy medical resources,large public hospitals speed up the turnover of their beds through rapid recovery and other means.For patients,the decline in average hospitalization days has promoted the healing of physical illnesses,but it's not enough for their recovery of mental problems to return home immediately.Without a regular and familiar doctor,it is difficult to accurately and comprehensively acquire every individual's health status,and it is not conducive to establishing a trustful relationship with the doctor.For the doctors and hospitals,the continuity of hospital record and medical care,and the establishment of long-term trusted doctor-patient relationships with specific patients can greatly reduce the risk of misdiagnosis,misdiagnosis,and recurrence of diseases,which can effectively improve the overall health status of citizens.While for the medical insurance funding,many patients' admission treatment and drug use are caused by poor disease control or insufficient care after illness.This research is aiming at solving this outstanding problem.Objective To improve the medical service system for the elderly,make up for the fault.China is now in the stage of rapid population aging,and the demand for medical services has reached a new plateau,therefore we are in urgent need of a comprehensive elderly medical service system.At present,the domestic elderly medical service system only focuses on the treatment of the disease itself.The general public hospitals at all levels that undertake the main medical tasks in China have strongly felt the capacity limitations,and the problems of endless patients and beds shortage have become increasingly prominent.The specific service forms of the elderly medical service system include health knowledge publicity,pre-hospital emergency treatment,in-hospital acute care,mid-term care,long-term care,and terminal care.At present,mid-term care in China is in a state of absence,it not only causes elderly patients return to the ward without plan,but also wastes medical resources and leaves patients various dysfunction problem.Methords Starting from the composition of the elderly medical service system,we analyzed the necessity of the mid-term care model through debriefing the composition of the elderly medical service system.Then we discussed the theory,model,software and hardware of the mid-term care,and the empirical analysis was performed in Orthopedics and Stroke Ward of hospitals under Medical Group with mid-term care.At last,we explored the role of TCM played in the field of mid-term care,and discussed the technical and policy issues of the current mid-term care in the Medical Group in order to get further improvement and development.Through theoretical research and empirical analysis to explore the indispensable role of mid-term care in the elderly medical service system,at the same time,it is feasible and effective to carry out mid-term care in community hospital under medical group.From the theoretical research methords,it reviews domestic and international mid-term care model firstly,elaborates research routing and methods,and discusses the implementation of mid-term care in the hospitals under Medical Group,which is a service model that is suitable for Chinese background and traditional culture,and also reflects Chinese characteristics.It has theoretical and practical significance for the integration and continuity of elderly medical services.It traces the history and related components of elderly medical services.Whether in West or East countries,elderly medical services have existed for a long time.The necessity of building an integrated elderly medical service is discussed from the aspects of aging theory,life expectancy extension,to the change of the disease spectrum.This chapter illustrates specific service forms of the elderly medical service system including health knowledge imparting,pre-hospital emergency treatment,in-hospital acute care,mid-term care,long-term care and terminal care.There is a gap between acute care and long-term care,and some patients with acute diseases directly enter long-term care as they hadn't received effective and safe mid-term care,and they were admitted to the hospital without plan and repeatedly,or they didn't get full recovery,even had been disabled.It discusses the concepts and models of mid-term care from a theoretical perspective.This chapter illustrates the definition,objects and forms of mid-term care,and the software and hardware atmosphere required to carry out mid-term care are clearly elaborated.The "service chain theory" and "continuous care theory" are used to discuss this research.Medical service is an integrated product,due to the health policy and other reasons,there is some disconnections where it should form a "value chain" of medical service processes.The kernel of the "continuous care" theory is to care for the elderly's life on all aspects,and exert ourselves to allow elderly people with different levels of needs to live in familiar places for long enough time with good care.There are relevant theories supporting the need for mid-term care modelIt elaborates the theoretical feasibility of mid-term care in community hospital under Medical Group firstly.The Medical Group is an organizational structure formed by the combination of different levels of medical institutions under the background that medical resources are distributed imbalance in China.The mid-term care in the facility of grass roots under Medical Group are an effective way to implement hierarchical diagnosis and treatment.It's important in implementing continuous health management,also has some advantages including more government support,complementary of resources,greater convenience,increased income,and reduced costs.Therefore,it is imperative to carry out mid-term care in the facility of grass roots under Medical Group.Then discusses the effectiveness of mid-term care for elderly patients in the community hospital under Medical Group through empirical analysis.100 patients with rotator cuff injuries in Northern Jiangsu People's Hospital was divided into two groups,of which 52 were experiment groups in Tangwang orthopedics cooperated ward,received mid-term care,and 48 patients without mid-term care were control group.The statistical comparison of the postoperative rehabilitation effect and UCLA scores showed that the mid-term care was more effective;300 patients with stroke from Northern Jiangsu People's Hospital were divided into two groups,of which 162 were experiment group who received mid-term care in Xinji community hospital,other 138 cases were control group.Statistical comparison with ADL scale,GDS-15 scale,FRA scale,and EQ-5D scale showed that mid-term care has significant clinical effects in elderly stroke patients after the acute phase,and it is a new type of care model that can create high added value.The earlier the mid-term care is performed after the stroke in elderly patients,the better the effect.A sample of 208 patients with CPI surgery for acute myocardial infarction in Taizhou People's Hospital were divided into two groups,of which 100 were transferred to the Gaogang District People's Hospital as an experiment group with mid-term care,and 108 patients were discharged home undertaking general rehabilitation without mid-term care.The comparison of the anxiety and depression self-assessment scale and the rate of postoperative complications showed that mid-term care is beneficial to the postoperative recovery of elderly patients with acute myocardial infarction after CPI surgery,and achieves both physical and mental rehabilitation which is also safe and effective.It also have supplemental instructions of advantages of TCM(Traditional Chinese Medicine),current policy and technical issues in mid-term care.Firstly it explains the positive effect played by TCM(Traditional Chinese Medicine)in mid-term care.Starting from the unique theory and clinical advantages of TCM,this article analyzes the relevant effects that TCM can have in mid-term care,for example,in mood,diet,and medication.The TCM clinic in the Yangzhou Medical Group operates very well.The specialty of TCM bone injury has a long history,combined with technique of western medicine of bone injury,has played an active role in mid-term care.In the mid-term care in the hospitals under the Medical Group,we must continue to work on the study of TCM theory,promote the standardization of mid-term care of TCM,pay attention to the network construction of mid-term care with TCM,finally to make TCM,the cultural treasure of our country,play an important and wonderful role in the elderly medical care services.And summarizes the current policy and technical issues in the implementation of mid-term care in the hospitals under the Medical Group.Rehabilitation technology and comprehensive assessment technology for the elderly are two key technologies in the mid-term care.Investigations on the implementation of mid-term care(mainly rehabilitation treatment)in the Medical Group showed that the ability of primary rehabilitation is weak.While comprehensive assessment technology for the elderly has just initiated recently,and isn't spread quite well.We should also pay attention to some problems including the demand for further optimization of medical insurance payment methods,the inability of tertiary hospitals to carry out related services,the lack of software and hardware standards,the performance allocation plan to be determined,the profit to be improved,the lack of specific disease effect evaluation indicators,and others like multiple medications for the elderly,delirium management,falls and aspiration,etcIt forecasts the future development of the mid-term care model.The rise of Internet hospitals has greatly promoted the development of mid-term care.This article introduces the application of "Internet+" and the big data in mid-term care.It is proved to be promising with the positive effect produced in the Internet hospital of Northern Jiangsu People's Hospital;the running of day surgery also opens up the market for mid-term care.Under the Medical Group model,large public hospitals and facility of grass roots should strengthen their collaborations.Large public hospitals should be responsible for day surgery,and after surgery,sending patients to facility of grass roots to receive mid-term care.The follow-up comparison between home rehabilitation and mid-term care in facility of grass roots of patients with day surgery at Northern Jiangsu People's Hospital showed that mid-term care is beneficial to improve the patient's medical experience and their recovery.The elderly medical service system which mid-term care is added,is more diversified in service types,more perfect in service modes,and more continuous in service connection.It has the basic elements of a complete geriatric medical service system.However,there are still some problems,such as the fragmentation of management system,the difficulty of sharing information platform,the disconnection between medical insurance and service,the lack of elderly leading institutions,the shortage of elderly nursing and rehabilitation talents,which need further study.Results The research based on Chinese characteristics and has found out the most suitable medical organization environment for implementation of mid-term care is the community or county hospitals under Medical Group.It also matches the National demand of Referral between different level of hospitals and Triage for acute or chronic patients,and is conducive to the recovery of elderly,promotes the development of county or facility of grass roots,and builds a life-cycle elderly medical service system.The insufficient is that the research is mainly based on theoretical deduction,the sample size is small,and there are certain limitations in spreading experience to other institutions.Conclusion With the advent of China's aging society,and the upsurge of huge elderly medical needs,we need to make up for the missing part of the elderly medical service system through mid-term care in order to face elderly patients with complex needs.Therefore,mid-term care in the institutions of Medical Group is suitable for Chinese characteristic and is an efficient model to make up for the missing part of the elderly medical service system. |
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