On the morning of April 15, Wan Tao, the person in charge of the family bed of the Liulitun Community Health Service Center in Chaoyang District, Beijing, carried the outpatient box on his back and walked in the winding alleys and tall and low buildings to serve the patients in the family beds.
The Liulitun community is small in size, with an area of 4.48 square kilometers. Usually, Wan Tao only needs to walk a few minutes to reach a patient's home, and to go to a distant resident's home, he can reach it in less than 15 minutes by bicycle.
In the early morning of April 15, Wan Tao, a doctor at the Liulitun Community Health Service Center in Chaoyang District, Beijing, and Wang Qinghua, the head nurse, rushed to the patient's home. Photo by Niu Hongchao
For Wan Tao, this is his daily routine for 7 years. In 2017, Beijing tested the waters of family hospital beds in a number of primary medical and health institutions, and the Liulitun Community Health Service Center was one of them.
In the past seven years, the center has set up a total of 186 family beds, 1,486 door-to-door bed rounds, 231 door-to-door catheterizations, 604 door-to-door blood draws, 374 door-to-door dressing changes, and 7,715 door-to-door treatments.
With the deepening of the aging population, the family bed service came into being as an extension and expansion of the family doctor service system.
"Rest" a hospital bed at home
In early spring, the warm sunlight penetrated through the window and sprinkled on the body of 83-year-old Jiang Guiying (pseudonym).
Jiang Guiying's room is the best lit room in the house, and in addition to the hospital bed under her, there is also a TV not far away. "Is Dr. Wan here? Didn't he call yesterday", Jiang Guiying turned her head to look at the door, "Change my clothes and comb my hair, I have to see him in good spirits." ”
Half a year ago, Jiang Guiying, who had been bedridden for many years, had a ghost door, cerebral infarction combined with pulmonary embolism, and the situation was very critical. When things got better, she was transferred back to the Liulitun Community Health Service Center. It was here that they first heard about the family hospital bed.
On April 15, Dr. Wan Tao and Wang Qinghua, head nurse of the Liulitun Community Health Service Center in Chaoyang District, Beijing, examined the body of patient Jiang Guiying. Photo by Hou Jiaxin
"I put the hospital bed at home, and there are doctors and nurses who come to the door regularly, I never thought that it could be like this!" Jiang Guiying told the Health Times reporter that with Wan Tao's help, the procedures for the family hospital bed were quickly completed, and she returned home as she wished. In order to make her live more comfortable, her son and daughter-in-law are also equipped with special anti-decubitus air cushions.
As the doorbell rang, Jiang Guiying's son quickly walked to the door and welcomed Wan Tao and Wang Qinghua in.
"Aunt Jiang, does your leg still hurt? How is your body feeling in the past two days?" As soon as they entered the door, Wan Tao and Wang Qinghua came to Jiang Guiying's room with a familiar car, measured blood pressure, did an electrocardiogram, and checked their body...... Jiang Guiying was in good spirits this day, and responded with a smile, "Eat well, sleep well, I don't feel like I need to take medicine!"
Wan Tao slowly helped Jiang Guiying up with one hand, and checked Jiang Guiying's legs and feet with the other. "When I was young, I was engaged in construction, and this piece of house was built by our unit, and in 1958, I accidentally fell into the ditch from the three-wheeler, and then I fell ill. ”
Jiang Guiying's son, who is also in his 50s this year, told the Health Times, "Because of cerebral infarction rehabilitation treatment and reexamination, I need to go to the hospital twice a week." But we are an old building, there is no elevator, and we can only call 120 to go up and down the stairs, and we have to toss for a day to go to the hospital. Now the doctors and nurses come directly to the door, and they really solve a big problem for us! Every time they come, we feel very sure. ”
Wan Tao introduced that there are many elderly residents in the community, and the elderly, stroke paralysis and other disabled elderly need regular examination, treatment, drug adjustment and later rehabilitation. In normal times, for basic medical services such as urinary catheter changes and regular infusions, family members often need to spend a lot of energy and physical energy to take care of patients, ask for leave, send them to the doctor, and register...... It not only breaks the hearts of the family, but also makes the patient tired and tired, and cannot get a better rest.
In order to meet the needs of patients like Jiang Guiying who meet the conditions for hospitalization and need continuous treatment but are unable to take care of themselves or have difficulty moving, in October 2017, the Liulitun Community Health Service Center established a family bed department on the basis of the original family doctor signing a door-to-door visit, to establish family beds for special groups such as empty nesters, the elderly, and those who have lost their independence, especially residents who meet the conditions for building beds due to illness and mobility, and provide door-to-door medical treatment, nursing, rehabilitation and other services.
"Hospitalized" at home can also use medical insurance
Dr. Wan Tao, 44, has been working at the Liulitun Community Health Service Center for 15 years. As a doctor in the general practice of traditional Chinese medicine, in addition to daily diagnosis and treatment, he is now also responsible for the management of family hospital beds in the jurisdiction. At its peak, Dr. Wan Tao was responsible for the management of patients in 15 family beds, the oldest of whom was 101 years old. He often takes a lunch break or after work to visit patients' homes.
In Wan Tao's view, "Some of these patients have been with me for many years, just like the old people in their own family, and they are always thinking about it. While talking, along the road, residents who came back from grocery shopping and Dr. Wan Tao greeted each other warmly.
On April 15, residents who came back from grocery shopping along the road greeted Dr. Wan Tao and head nurse Wang Qinghua warmly. Photo by Hou Jiaxin
Coming out of Jiang Guiying's house, entering another community, climbing to the fourth floor, behind a hidden door, is Wang Dachuan (pseudonym) home. He used to be 180 pounds, but now he is tortured by illness to less than 140 pounds, and his complexion is not very good. Seeing Wan Tao, although he couldn't speak very clearly, Wang Dachuan still tried his best to greet Wan Tao.
"The old man has been paralyzed for more than four years, and he has epilepsy, and he has a seizure every now and then. Wan Tao told reporters, "Last year, because of urinary tract infection, we were hospitalized in our center, and when we saw that the elderly could not take care of themselves, we communicated with the family members to see if we could build a family bed. ”
Under the careful care of Wan Tao and others, Wang Dachuan's urinary tract infection problem was quickly solved, and not only that, but the epilepsy that had been bothering him for a long time had no seizures.
"When I got sick, my nanny and I couldn't hold him down, and the worst one was a dislocated jaw, and he kept foaming at the mouth, sometimes tossing and turning all night, and we were also worried, but now I can sleep peacefully. Speaking of the changes after the establishment of a family hospital bed, Wang Dachuan's wife couldn't help but sigh.
"We spent a total of 4,000 yuan during our hospitalization, and nearly 3,000 yuan were reimbursed, and the self-paid part was only more than 1,000 yuan. Wang Dachuan's wife said excitedly that good policies allow his wife to get better care, and they can still afford it.
Wan Tao told reporters that the doctor's single visit fee is 80 yuan, the nurse's visit fee is 50 yuan, and the rest of the medical services are billed according to a single time, taking catheterization as an example, a single 20 yuan, these services are reimbursed according to the proportion of hospitalization, and the reimbursement ratio is more than 90%.
In December 2016, the Beijing Municipal Human Resources and Social Security Bureau announced that the medical expenses of community family beds in Beijing were included in the scope of basic medical insurance reimbursement, and the starting line is expected to be reduced by 50%, from 1,300 yuan to 650 yuan. If the insured person goes to a community medical institution for medical treatment, the outpatient reimbursement rate can reach 90%.
In addition, therapeutic family beds can be transferred to community health institutions or large hospitals, and large hospitals can also be transferred to family beds to achieve two-way referrals.
For elderly people like Jiang Guiying and Wang Dachuan, being able to enjoy the same medical services at home as in a hospital provides an additional option for improving their own recovery.
Six categories of patients can apply for family beds
Since the launch of the family bed service in 2017, a total of 186 family beds have been built in the Liulitun Community Health Service Center, with 1,486 door-to-door bed rounds, 231 door-to-door catheterizations, 604 door-to-door blood draws, 374 door-to-door dressing changes, and 7,715 door-to-door treatments.
In addition, the center has established 26 family doctor teams, each of which serves the corresponding community contracted residents, with 34,469 contracted residents in 2023 alone, with a contract rate of 45.95%. In addition to providing family doctor contract services, we also carry out family hospital bed construction services for patients in need.
"The 'family bed' is an extension and expansion of the family doctor service system. Patients can enjoy both the national medical insurance policy and the home medical services provided by doctors. The number of patients who apply for family beds is generally the elderly, chronically ill, bedridden, and mobility patients, as well as those who need continued treatment and care after being discharged from the hospital. Wang Yanhong, deputy director of the Liulitun Community Health Service Center, told reporters, "From the point of view of procedures, the patient is still a patient in the hospital." Therefore, there is no need to register back and forth to see a doctor, and there is a 'green channel'. ”
On April 15, Wan Tao and Wang Qinghua visited all the patients and residents in the morning, and discussed their conditions as they walked back to the hospital. Niu Hong super-photographed
"To carry out family hospital beds, on the one hand, residents do have needs, and on the other hand, community grassroots medical personnel must have the ability to provide clinical medical care. In Wang Yanhong's view, compared with hospital beds, medical staff cannot stay with patients all the time, and at the same time, the diagnosis and treatment environment and conditions are relatively weak, and medical safety is crucial. After the patient submits the application, it is necessary to pass the bed assessment, and the conditions such as a clear diagnosis, stable condition, non-critical disease, and palliative care in the terminal stage of the disease are the thresholds.
It is understood that the "family bed" service model is aimed at patients who have the need to build a "bed" and meet the standard of building a "bed", according to the principle of "one person, one file" to set up a family bed, family doctors will regularly provide a series of rich and professional door-to-door medical services such as bed rounds, consultations, treatment, nursing and rehabilitation according to the patient's health status.
"For families in need, the current process of applying for family bed service is that the patient or family member applies to the contracted institution for bed construction, and brings the patient's relevant medical history and ID card to the selected contracted institution to apply for treatment. If the contracted institution determines the construction of a bed after organizing an assessment of the bed construction, it shall go through the procedures for building a bed at the contracted institution according to the hospitalization procedures. Wang Yanhong said that at present, family bed services mainly include general medicine, basic nursing, rehabilitation care, pharmaceutical services, etc., and can enjoy medical insurance services.
In 2007, the former Beijing Municipal Health Bureau promulgated the Measures for the Management of Family Hospital Beds in Community Health Services (for Trial Implementation), encouraging citizens suffering from six diseases to apply for family beds and receive medical services provided by community medical staff. At present, Shanghai, Jiangsu, Guangdong and other places are piloting the development of family beds.
Wang Yanhong said that the family bed service is a big test for primary medical institutions. Compared with the traditional outpatient model, home service requires more time and effort from medical staff. A family hospital bed is a few hundred meters away from a community health center and three or four kilometers away. For door-to-door visits, medical staff have to cross traffic lights, enter the community door, pass through the corridor access control, climb stairs or take the elevator, and the energy paid is much greater than that of in-hospital rounds.
"People need to build beds, so we have to do it. If you encounter a problem, you will take more measures to solve it, and you will always find a way to explore little by little. In Wang Yanhong's view, "building a bed is a responsibility, no matter the wind, frost, rain and snow, no matter spring, summer, autumn and winter, as long as the people need, we will do our best to be their most solid support." ”