Xing Ruoqi, deputy director of the Department of Medical Affairs of the National Health Commission, released a statistic in response to reporters' questions, "At present, a total of more than 3,000 medical institutions provide more than 60 medical care services in 7 categories, and patients can receive corresponding nursing services at home."
A few days later, at a press conference held by the National Health Commission, Xing Ruoqi announced the number of registered nurses in the country and elaborated on the new situation facing nursing work.
Overall, clinical nursing is becoming increasingly stressful. It said that on the one hand, the process of aging society is accelerating, most of the elderly have multiple diseases, and the social demand for geriatric care and geriatric care related to chronic diseases is increasing; On the other hand, the survival period of patients with chronic diseases is increasing, the demand for nursing and rehabilitation is increasing, medical diagnosis and treatment is growing rapidly, and the number of inpatient services is increasing.
At the press conference held by the National Health Commission on the theme of nurses and nursing, keywords such as Internet nursing and door-to-door nursing were repeatedly mentioned, among which at the press conference on May 7, in addition to explaining that more than 3,000 medical institutions can provide home care projects, in terms of geriatric medical care, Beijing, Shandong, Jiangsu and other regions, a large number of social forces held nursing homes and nursing stations play an obvious role.
Continuum of care may have become a new trend in the development of nursing work.
Continuity of Care is a patient-centered model of care that aims to provide patients with continuous, consistent, and high-quality care across different health care settings, such as from hospitals to community or home care. This model of care emphasizes effective communication and collaboration between different healthcare providers throughout the patient's treatment and recovery to ensure that patients receive a continuity of medical and nursing care.
1. Patient-centered: Continuum of care emphasizes the development of a personalized care plan centered on the patient's needs and preferences to ensure that the patient receives consistent treatment and care in different care settings.
2. Cross-sector collaboration: This model of care requires close collaboration between health care professionals from different fields, including doctors, nurses, rehabilitation specialists, and community caregivers, to provide comprehensive care to patients through effective communication and information sharing.
3. Flow of information: The success of the continuum of care depends heavily on the flow of patient health information. The use of electronic health record (EHR) systems can ensure the accuracy and timeliness of patient information to support care decisions.
4. Patient Education and Engagement: Educating patients and family members about the importance of disease management and health maintenance, and encouraging them to actively participate in the development and execution of care plans, is key to improving the effectiveness of continuum of care.
5. Quality and effectiveness evaluation: Regular assessment of the quality of care and patient satisfaction is essential for continuous improvement in the delivery of continuum of care. This includes monitoring the patient's health, the execution of the care plan, and feedback from the patient and family.
6. Challenges and opportunities: Despite its obvious advantages in theory, continuum of care faces many challenges in practice, including resource allocation, fragmentation of the health care system, and communication barriers between professionals. However, with advances in technology and innovations in health care models, continuum of care offers significant opportunities to improve patient care experiences and health outcomes.
In summary, continuum of care is a comprehensive, coordinated, and individualized care model that provides patients with continuous, consistent, and high-quality care through cross-domain collaboration and effective information flow, which is the key to improving the efficiency of the health care system and patient satisfaction.
Imagine if you are sick, you can consult a doctor in advance without going to the hospital, and you can still have a nurse to take care of you after being hospitalized, and you will still complain that the hospital allows patients to be discharged within 15 days?
Based on the above situation, the health community interviewed more than 20 front-line nurses through telephone calls and questionnaires. The purpose of this study is to understand the current implementation and implementation of Internet nursing in different levels of medical institutions in various places, as well as the experience and feelings of nurses themselves on home nursing.
All provinces have carried out "Internet + nursing" to varying degrees
Most nurses still have concerns
Among the more than 20 nurses interviewed and surveyed, they are mainly from 9 provinces and cities, including Henan, Fujian, Guangxi, Hunan, Shaanxi, Jiangxi, Shanxi, Anhui and Beijing.
We found that most of the medical institutions surveyed have launched "Internet + nursing" services. It is understood that primary medical institutions such as Quanzhou Hospital in Fujian Province and Jili Hospital in Liuyang in Hunan Province have set up door-to-door nursing services, but most of the primary and primary medical institutions have rarely touched it.
A nurse from a tertiary university in Beijing told the health sector that although she frequently receives orders for "home care", she rarely receives home care through her own hospital, and her hospital has not yet opened online nursing services, and most of its business is carried out through third-party platforms.
Among the medical institutions surveyed, although more than 52% of the medical institutions have opened Internet + nursing, in fact, 73.68% of the nurses said that they rarely carried out home care.
A male nurse from Zhengzhou University Grade III Hospital said that he had provided free home care several times, but based on the fact that he was already familiar with the patient's family, his attitude towards home care was that he did not have time, and second, he had safety concerns.
Among the more than 20 nurses interviewed, on the one hand, 57.89% of the nurses believed that home care could increase their income; On the other hand, nurses have been concerned about the safety of nurses, medical risk control, and fee payment mechanisms.
Taking Henan as an example, in 2021, Henan Province began to carry out the "Internet + Nursing" pilot, and at present, hospitals at and above the second level have basically carried out door-to-door nursing services.
Henan Jiyuan Second Hospital has done relatively well, with nearly 300 orders a month, and Jiaozuo Second Hospital has about 200 orders per month; Most medical institutions have about 10 orders per month for home care services, and only about 100 orders per year. It is understood that since the "home care" service was officially launched in November 2021, as of April 2024, there have been a total of 149 registered nurses. 1,226 person-times of service were completed.
"If you want to revitalize, you must have nursing characteristics, for example, Jiaozuo Second Hospital has been able to revitalize the home care service through traditional Chinese medicine baths." In addition, in the face of nurses' own safety concerns, first, medical institutions purchase medical liability insurance and accident insurance for nurses; The second is to leave traces throughout the service process, positioning tracking and one-key alarm; The third is to promote service enthusiasm by improving the service performance of nurses.
Nurses pay more than their salaries for home care
To expand the team of nurses and improve the level of nursing, nurses' income not only needs to be increased by reasonable performance distribution, but also the nurses who frequently participated in home care in the interview, some of whom have higher income than their salaries, and some have bought houses or cars in Beijing to open restaurants.
For example, some nurses in interviews said that "sometimes the income for home care services is higher than the combined salary".
The above-mentioned nurse from Beijing University Tertiary Hospital said that she began to do door-to-door nursing in the second half of 2016, and from 2017 to 2018, several third-party door-to-door nursing platforms were born, and the platform spent a lot of money to attract nurses to settle in, "Nurses can have a 120%-140% subsidy as long as they settle in the platform to receive orders.
However, it was also the early entry that this nurse received more than 600 orders from 2017 to 2019, plus extra, the number of indirect orders in three years was about 1,200. But now that there are more nurses and third-party platforms are also increasing, the number of individual nurses receiving orders is not as good as before, "Now the platform does not give push orders, and even blocks the mobile phone numbers of our part-time nurses."
Of course, there are also full-time workers, the above-mentioned nurse from a tertiary hospital in Beijing said that she "knows a full-time nurse, who has been working since around 2019, and earning 2,000 a day is not a problem, and when I was in Sichuan before, my salary may have been only two or three thousand, and now I have bought two cars in Beijing, although I have not bought a house, but I have opened a restaurant this year."
In the interview, we found that nurses will also derive some other services in the process of home care, such as many patients do not want to go to the hospital next time after infusion, nurses can pay for prescribing medicine; Sometimes there will be some need for diet pills and infusion whitening injections.
For nurses, home care is not only a higher income, but also an increase in the sense of gain. A nurse with 30 years of nursing experience at Jiaozuo Second Hospital said, "After meeting the needs of patients, the sense of self-worth of home care will be enhanced. In addition, the sense of trust from patients has also increased."
There is still a long way to go
At present, all provinces and cities across the country have more or less carried out "Internet + nursing", but some have just started, and some have not fully played a role.
Zhao Jingsheng, who has been in the field of Internet medicine, participated in the pilot of "Internet + Nursing" in Xiamen in the early years.
At that time, Fujian identified two medical institutions in Xiamen as pilots, and Zhao Jingsheng, as the person in charge of one of the pilots, met a state-owned enterprise in Xiamen with no medical background, and had a strong desire to make a regional door-to-door care platform, and wrote a plan for the local health commission. Subsequently, the National Health Commission organized a meeting of various hospitals to discuss, and as a result, major hospitals were reluctant to "accept the recruitment".
On the one hand, the outpatient volume of Xiamen University is large, and the nurses are very busy and have no time, and on the other hand, all kinds of risk management, operation mechanisms, and even how to distribute profits are all in a state of "no law".
Hospitals also have hospital considerations. Zhao Jingsheng recalled that at that time, the whole of Xiamen was indeed actively promoting "Internet +" nursing and was also actively looking for solutions.
In addition to home care, the pilot hospitals also summarized some other Internet-driven nursing services at that time, such as Huang Zhongqin, director of the nursing department of Xiamen Fifth Hospital, who has been planning out-of-hospital chronic disease management; The second block is home care; The third block is the continuous service of the combination of inside and outside the hospital with some specialties, such as the postoperative management of some abortion and other surgeries, and the closed-loop management such as follow-up and follow-up.
At that time, the Xiamen Pilot Hospital borrowed from the model of the Second Affiliated Hospital of Zhejiang University School of Medicine ("the Second Affiliated Hospital of Zhejiang University") and other places in China. All hospital charges must be based on the medical insurance fee items in the hospital, even if it is a self-pay item, there is no charge item.
For a time, the charge became an issue. At that time, the only suitable policy was the family ward, but after calculating an account at that time, it was found that this was also "a waste of input, and the input and output were not proportional".
Later, the pilot hospital also explored independent pricing according to the nurse rank, "but the nurse service plus the cost of transportation, plus the cost of insurance, plus the cost of treatment and consumables, the total per capita received about 300~700, what should I do if the hospital still can't collect this money?"
The more acceptable solution for hospitals is to cooperate with a third-party platform, the hospital is responsible for the diagnosis and treatment and medical quality management within the scope of professional capabilities, and the third-party platform is responsible for the provision of professional operations and other supporting services.
However, out of risk considerations, the hospital later ran a few orders for the patients for free.
Overall, after interviewing more than 20 people, we found that most of the current home care services are still carried out by third-party platforms, and although public medical institutions have carried out them, the number of orders is small. In addition to medical safety and nurses' own safety concerns, there are also issues such as whether medical insurance is open and how to price projects.