Planning Study For Shanghai Disabled Rehabilitation Services System

1. Study Significances and ObjectivesRehabilitation refers to using comprehensive, coordinated medical, social, vocational, educational measures at different institutions to train patients to achieve the highest possible level of their ability. Rehabilitation services can effectively compensate physical and functional defects of the disabled, reduce the burden of disability, improve quality of life for disabled and their families, release potential labor force, create social wealth.Medical rehabilitation is the basis of rehabilitation services. To ensure that disabled are access to scientific and systematic medical rehabilitation services and the continuous effect of medical rehabilitation services, there must be a reasonable medical rehabilitation service system. There are four systems can provide relevant medical rehabilitation services, CDPF rehabilitation system is the main provider, known as disability people rehabilitation service system.Shanghai has built a comprehensive disability people rehabilitation service system, constructed by rehabilitation institution in the municipal, district and street. With the aging of Shanghai population, more frequent population movements, quicker working pace, increased accidents, environment pollution, increasing the risk of the occurrence for disability. Meanwhile, rapid development of economic, social, rehabilitation theory and technology, the disabled rehabilitation services consciousness gradually growing up, Shanghai disabled rehabilitation service system needs to face increasing challenges and pressures.This study aims to determine the meaning of the Shanghai disabled rehabilitation services system, analysis status and problems of Shanghai disabled rehabilitation services system, make optimization strategy for system, and implement such strategy.2. Materials and MethodsFirst, using class analysis to summarized connotation elements for disabilities rehabilitation, literature -based meta-analysis to conclude connotation of disabilities rehabilitation, analyzing connotation trajectory at home and abroad, determine factors influence rehabilitation connotation, and then rehabilitation connotation for shanghai, deduced connotation for disabled rehabilitation services system. Second, based on previous study, obtain status and problem of rehabilitation service system, determined problem for different level institution of rehabilitation through normative gap analysis. Learning from the system status at abroad and policy requirements at home, to derive the formation and function of the Shanghai service system and different level institution, building optimization strategies to address the problem of different level institution. Finally, basing on regional planning theory, determine the planning for Shanghai sunshine rehabilitation center in next phase,The main sources of information included literature review, field surveys and qualitative interviews. Summarizing and analyzing literature to determine connotation elements of disabilities rehabilitation, disabilities rehabilitation connotation, rehabilitation connotation trajectory at home and abroad, status and problems of Shanghai disabled rehabilitation services system. Through field surveys and interviews with experts, obtain configuration status of Beijing United Family Rehabilitation Hospital, China Rehabilitation Center, Rehabilitation Department of HuaXi Hospital of Sichuan University, Sichuan eighty-one Rehabilitation Centers, Guangzhou Vocational Rehabilitation Centers and configuration, planning proposals for Shanghai Sunshine Rehabilitation Center.3. Main ResultsA. Connotation of Shanghai Disabled Rehabilitation Services SystemConnotation element for disabled Rehabilitation contains the purpose of rehabilitation, content of rehabilitation, rehabilitation measures, rehabilitation provider and rehabilitation object. The United Nations and china disabled rehabilitation content development trajectories are analyzed, showed that there is still a gap between china and United Nations. Factors affecting connotation are the development of social, economic and needs of disabled. The gap for economic and social development between shanghai and the developed countries is narrowing, while the demand for rehabilitation services is gradually released, therefore, Shanghai should have the current connotation of disabled rehabilitation. Further, based on the purpose of the Shanghai disabled rehabilitation service system, the connotation should be:based on reducing the impact of disability, compensating for the damage caused by the injury, using sociology, psychology, education, engineering, information science and other methods and techniques of professional rehabilitation, provide rehabilitation, disability secondary prevention in Shanghai disabled rehabilitation service system.B. analysis of the status of Shanghai Disabled Rehabilitation Services systemShanghai disabled rehabilitation services system consists of municipal, district, street tertiary rehabilitation institution. Shanghai municipal rehabilitation institutions have two rehabilitation centers, vocational training center sunshine rehabilitation center; district has 20 rehabilitation institution, located in 17 zones, each have 1 to 3 centers, all centers are second and third health care institutions; street rehabilitation institutions have 251, located in 219streets, each street has 1 to 2 community rehabilitation station, all stations are community health service centers. Currently, rehabilitation institutions at all levels did not determine their function and position clearly, the body of sunshine center is inadequate and vocational center is not professional; access standards of district rehabilitation institutions are not unified, cooperative mechanism is not perfect; manpower of street rehabilitation institutions is inadequate. Meanwhile, the architecture of Shanghai disabled rehabilitation system is loose, mutual guidance and referral relationship of rehabilitation agencies at all levels did not exist.C. Construction of Optimization Strategies for Shanghai Disabled Rehabilitation SystemShanghai disabled rehabilitation system is mainly responsible for sub-acute and chronic rehabilitation services demand of disabled, sunshine rehabilitation center is positioned as sub-acute rehabilitation agencies, technology resource center for Shanghai medical rehabilitation, undertake clinical patients with sub-acute demand; vocational training centers provide vocational training and rehabilitation for deaf children, technology resource center of rehabilitation of deaf children and vocational training. District-level Rehabilitation institution is positioned as sub-acute rehabilitation center, providing sub-acute rehabilitation service. Street community rehabilitation station is positioned as stabilized patient’s general medical rehabilitation institutions, providing general medical rehabilitation services. Municipal provides technical guidance to the district, and district to the street.Firstly, Shanghai sunshine rehabilitation center need to be bigger and stronger, leading Shanghai disabled rehabilitation service system; vocational training center need to be more professional in its field. Secondly, municipal federations need to develop district-level access standards, districts federations improve access standards considering its own characteristics; Meanwhile, to ensure the effect of rehabilitation services, there is need to establish mechanisms for cooperation between CDPF and rehabilitation centers. Finally, combined with the needs of the disabled, should plan the configuration and carry step by step.Shanghai sunshine rehabilitation center is the key institutions, affecting connotation realizing and Shanghai disabled rehabilitation services system function implementation, needed to implement its optimization strategy.D. the development of Shanghai Sunshine Rehabilitation Center Development PlanShanghai sunshine rehabilitation center will leading Shanghai disabled rehabilitation services system. Based on international vision, center should aim at the forefront of this field, combine health, education and research.Impact factors for Shanghai sunshine rehabilitation center are beds, the building area, rehabilitation manpower, rehabilitation equipment. The planning methods refer to " basic standards Rehabilitation Hospital (2012 edition) ". By investigation for configuration of Beijing United Family Rehabilitation Hospital, China Rehabilitation Center, rehabilitation department of HuaXi Hospital of Sichuan University, Sichuan eighty-one Rehabilitation Centers, Guangzhou Vocational Rehabilitation Centers. Shanghai sunshine rehabilitation center must be configured to 961 beds,231 rehabilitation physicians,230 rehabilitation therapists,260 nurses,230 logistics management and other personnel; 22.95% of the rehabilitation physician title are senior,37.71% are intermediate,39.34% are primary; 10% of the rehabilitation division titles are senior,30% intermediate,60% the primary. In addition, need 144150-153760 m2 of building area; added two large rehabilitation equipment each type.Dividing the implementation of planning into three steps, the first step took four years, from 2014-2017, rehabilitation beds increased 250; second step lasted 2 years from 2018-2019, rehabilitation beds increased 200; third step lasted two years from 2020-2021, rehabilitation beds increased 250.4. Main conclusionsA. Improving disabled rehabilitation can deal with current demand pressures and challenges from disabled rehabilitation service.B. Connotation for Shanghai disabled rehabilitation services system claims with diverse targets and more professional rehabilitation institutions, can make up for deficiencies in Shanghai on current public service.C. Establishment of rehabilitation institutions in medical institutions can achieve tripartite win.D. System optimization strategies fully consider the status of rehabilitation services in Shanghai, with high feasibility.E. Professional human resources is a key factor in implementation of planning, due to the current assumptions, there is need to carry out dynamic planning about rehabilitation beds and human resources.F. There is need for reasoning for planning of sunshine center, and make out access standards for district-level rehabilitation center, evaluation criteria for community rehabilitation stations in specific district.