The construction of specialties is an important starting point for promoting the high-quality development of public hospitals. A few days ago, the General Office of the State Council issued the "Opinions on Promoting the High-quality Development of Public Hospitals", which once again clearly proposed to "strengthen the construction of clinical specialties". In the new stage of high-quality development of public hospitals, how can the construction of specialties step up to a new level? What are the new measures for hospital management and discipline construction? Recently, the "Seminar on Promoting the High-quality Development of Specialties in The Promotion of The Standardization Construction of Enabling Action Medical Institutions" sponsored by Health News was held in Chengdu, Sichuan Province, and experts from all over the country in the fields of hospital management, clinical, medical insurance, and pharmacy took the development of rheumatism and immunology as an example and exchanged views around the construction of specialties.
National Health Commission Medical Administration Bureau
Heads of relevant departments: Innovative specialty development models
Lead the high-quality development of hospitals
The person in charge of the relevant department of the Medical Administration Bureau of the National Health Commission introduced the policy trend of the development of specialties in public hospitals. He pointed out that since the implementation of the medical reform policy, the volume of medical services has risen sharply, and the construction of connotation has also continued to progress. However, there are still difficult problems that need to be solved: the unreasonable structure of medical resources, the uneven distribution of high-quality resources, and the insufficient development of overall medical service capabilities and scientific research capabilities. In order to build a better and more efficient medical service system and make up for the shortcomings of scientific research capabilities, the state will vigorously build national medical centers, national regional medical centers and regional medical centers, promote the development of medical services from local to regional, gradually realize the homogenization of interregional medical services, and solve the problem of frequent medical treatment for the masses. Up to now, the establishment of 10 national medical centers has been completed, and a new batch of pilot projects for the construction of regional medical centers is being actively prepared.
From the perspective of development space, the future can be expanded in two directions. The first is the construction of the medical federation, which expands the development space through the formation of medical groups, forms a model of division of labor and cooperation between medical institutions, coordinates regional medical resources, and establishes specialized alliances. The second is the construction of one hospital and multiple districts, mainly the scale development, the division of the package section, the combination of prevention and control, through the system cooperation to form a management center and a resource center, reflecting the advantages of intensification.
The direction of discipline construction in China's hospitals is interdisciplinary and integrated development. The development direction of "three modernizations" is consistent, that is, internal surgery, minimally invasive surgery, and minimally invasive robotization, but there is too much cross-integration, and the current management methods cannot meet the needs of reality. Therefore, whether a centralized development model can be opened in the future, the relevant disciplines can be packaged, and the business scope can be expanded with a law to rely on, all need to be considered and discussed.
Xu Junbo is the Secretary of the Party Committee of the Third People's Hospital of Chengdu
Xu Junbo, chairman of the keynote speech session of the conference and secretary of the Party Committee of the Third People's Hospital of Chengdu, said that as the manager of the hospital, he deeply felt that the high-quality development of the department and the connotation construction of the hospital were crucial to the development of the hospital, which could effectively promote the hospital to embark on the fast track of high-quality development. In recent years, the state has successively issued important documents such as the modern hospital management system, the performance appraisal system of public hospitals, and the guiding opinions on the high-quality development of public hospitals. In particular, the "baton" of performance appraisal of public hospitals focuses on high-quality development. Our hospital conducts in-depth research on the main indicators of performance appraisal of public hospitals, such as minimally invasive surgery and the proportion of surgery, forms a closed-loop management model, and organizes the director of the department to hold an analysis meeting every two weeks to explore the improvement of quality and efficiency, which has played a positive role in promoting the high-quality development of the hospital.
Wang Li Vice President of Sichuan Provincial People's Hospital
Wang Li:
The construction of first-class disciplines is the development of hospitals
Foundation and core dynamics
Wang Li, vice president of Sichuan Provincial People's Hospital, shared her experience in how discipline construction leads the high-quality development of hospitals. The development of the hospital depends on the development of the discipline, and the construction of first-class disciplines is the foundation of the construction of the hospital. From the perspective of hospital administrators, discipline construction is the primary task, and building an excellent discipline group is the foundation of the hospital's high reputation. To do a good job in discipline construction, we must strengthen the foundation, build a platform, highlight the key points, strengthen cooperation, collaborative innovation, management support and performance orientation. Only if the platform discipline is strong, the clinical discipline will be strong. Hospitals should strengthen the investment of people and property, focus on support, make up for shortcomings, for example, the hospital has formulated the standard of medical teaching and research to select priority support disciplines, establish an evaluation mechanism, and 12 disciplines have received key support from hospital personnel and property. At the same time, strong disciplines are used to drive weak disciplines, and the goal of improving overall strength is to promote disciplinary integration, such as patient-centered discipline integration, disease treatment-centered discipline layout, and creating and promoting multidisciplinary diagnosis and treatment (MDT) treatment model.
From the perspective of the section director, the discipline leader is closely related to the team formation, discipline development planning, and the management of medical education and research. The responsibility of the department director is to be responsible for the discipline, the hospital, and the society. First-class disciplines require excellent academic leaders, high-level planning and high-level medical care. Such disciplines are the cradle of talent training, a professional training base and a high-impact research platform. In general, the construction of first-class disciplines must be premised on high-level standards, with high-level talent construction as the core, high-quality and safe medical technology as the pursuit, based on high-end scientific research level construction, and with the mission of cultivating first-class talents.
Liu Dongzhou is a professor of rheumatology at Shenzhen People's Hospital
Liu Dongzhou:
Take advantage of the policy to promote the development of rheumatic immunology
Professor Liu Dongzhou of the Department of Rheumatology of Shenzhen People's Hospital introduced that there are more than 200 million rheumatism patients in China, and the three major diseases with the most clinical attention and the largest number of consultations are: ankylosing spondylitis (more than 5 million patients), rheumatoid (more than 3 million patients), and lupus erythematosus (more than 1.2 million patients). Domestic awareness, treatment concept and normativity of rheumatism need to be strengthened. Taking ankylosing spondylitis as an example, the United States emphasizes the importance of biologics in treatment, while the proportion of domestic biologics used is generally low. With the improvement of disease awareness in recent years, drug treatment protocols have been continuously updated, and the therapeutic status of biologics has been continuously improved, so higher requirements have been put forward for the level of specialized diagnosis and treatment. In 2019, the National Health Commission issued guidelines for the development of rheumatology and immunology in general hospitals, which clearly defined the construction of rheumatology departments in tertiary hospitals from the policy level, providing a strong backing for promoting the development of immunology departments in general hospitals. The policy requires that the tertiary general hospital should set up an independent rheumatic immunology department, and promote the construction of the grass-roots rheumatology and immunology department, and the professional level has been improved, so that patients can go to the grass-roots level for diagnosis and treatment. This year, the National Center for Orthopedics and Sports Rehabilitation Clinical Medicine launched a spine integration diagnosis and treatment project to improve the diagnosis and treatment mode of chronic disease management, which is also beneficial to the development of departments and the diagnosis and treatment of patients. In addition, it is also necessary to strengthen academic exchanges and the training of young doctors, improve their scientific research level, and promote the development of disciplines.
Cao Li is the vice president of the First Affiliated Hospital of Nanchang University
Cao Li:
Multidisciplinary intersection is a new trend in the development of specialties
Cao Li, vice president of the First Affiliated Hospital of Nanchang University, introduced that the new trend leading the high-quality development of public hospitals is to strengthen the construction of clinical specialties, promote medical technology innovation, promote medical service model innovation and strengthen information support. The development of hospitals in the new era is to put people's health in a priority strategic position and open up new patterns, new systems and new ideas. The future discipline outlook is that the mirror has soft and hard, the subject has no inside and outside, both soft and hard, both inside and outside; the disease is the center, the discipline is integrated, the integration is integrated, and the coordinated development is coordinated.
The disease-centered multidisciplinary integration model is the development trend of medical treatment, the cross-integration of technologies between disciplines, the dilution of the concept of traditional specialties, the evaluation system of disciplines is being reconstructed, and the development trend of clinical technology in the minimally invasive era is the integration of various new technologies. The integration of diseases, originally based on specialization, is now based on ability, after the integration, cross-learning is very much needed. The development of today's medical technology has crossed the barriers of disciplines, blended with each other, and penetrated into each other. For the discipline to develop highly, it must be supported by scientific research and teaching, and have an interdisciplinary and multi-professional team. Taking the rheumatology and immunology department as an example, the biggest drawback is that the diagnosis process is difficult, and without the support of the MDT team, the diagnosis may be unclear and will bring organ damage to the patient. Our hospital has set up an MDT team to carry out multidisciplinary consultation, which has improved the level of diagnosis and treatment and allowed patients to receive high-quality treatment.
Yang Yong Deputy Director of the Department of Pharmacy of Sichuan Provincial People's Hospital
Yang Yong:
Biologics are used to treat patients with ankylosing disease
Bring new hope
Yang Yong, deputy director of the Pharmacy Department of Sichuan Provincial People's Hospital, introduced that the clinical manifestations and pathogenic pathways of rheumatic immune diseases are relatively complex, and there are many integrations with other diseases and disciplines. From a pharmacological point of view, how to block key factors through drug research and development to solve the problem of rheumatic immune diseases? In the pathogenesis of many diseases such as ankylosing spondylitis and psoriasis, there is a very key target - interleukin 17A (IL-17A), whether in the clinical field or the pharmaceutical field, interleukin 17 A has played a great role. Interleukin 17A inhibitors directly target the key regulatory links in the causes of ankylosing spondylitis, psoriasis and other causes, and the drug has strong specificity and good blocking effect, opening up a new era for the biological treatment of ankylosing spondylitis.
From the perspective of technological research and progress process, biologics have gradually transitioned from murine source to humanization and then to full human origin, and the requirements for biotechnology are getting higher and higher, while bringing lower immunogenicity and higher safety. More and more biologics for the treatment of ankylosing spondylitis are listed in China, for the target of interleukin 17A, such as the biological agent scuziyumab, the clinical efficacy is very good, and it is also a first-class choice for treatment from the perspective of evidence-based medicine: in the short term, the treatment week quickly relieves the patient's back pain, and the treatment weeks of morning stiffness and fatigue symptoms are relieved; in the long run, the patient's symptoms and signs are continuously relieved, and show good safety. Scuziyumab has been included in the national medical insurance directory through negotiations, and has obvious price advantages in similar therapeutic drugs, which further reduces the burden on patients, and at present, in Sichuan Province, it can be reimbursed by paying outpatients and entering pharmacies, which has good drug affordability and accessibility.
At the meeting, experts from all over the country in the fields of hospital management, clinical, medical insurance, and pharmacy took the rheumatology and immunology department as an example and discussed the construction of specialties.
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As the chairman of the roundtable discussion session, Liu Yi, director of the Department of Rheumatology and Immunology of West China Hospital of Sichuan University, believes that to promote the development of disciplines, it is necessary to optimize discipline indicators and empower emerging disciplines and cutting-edge disciplines. Discipline construction is a complex topic, one of the most important points is inheritance, without a complete ten-year top-level design for the development of disciplines, there is no real discipline construction. Rheumatology and immunology is a cutting-edge discipline, and its construction and development need to be continuously empowered and inherited. At the same time, disease is a transitional process, and the new era requires changes from research mechanisms to research models. In terms of disciplinary integration, we must not only stay in the simple integration of multiple disciplines, but also further improve the level of medical services.
Multi-departmental collaboration to create key specialties
Xie Xue, vice president of Chengdu Second People's Hospital, believes that high-quality development is inseparable from the improvement of medical service levels. At present, the hospital is building 10 national key specialties, taking the anesthesiology department of the key discipline in Sichuan Province as an example, mainly carrying out the following work: First, the quantity and quality are the same, increase the introduction of discipline talents, and attract more talents to the hospital to study and develop through word-of-mouth effect. Second, advocate the center to drive, control quality and safety according to national standards, advocate innovative models, expand internal and external, and improve medical services, such as the development of day surgery, that is, to train the backbone doctors of the discipline, but also to enhance their self-confidence, they are willing to do such a breakthrough. Third, supervise the development goals of disciplines, build disciplines with height, depth, brightness, and temperature, and need to have clear goals, and the hospital has put forward a three-year and five-year plan for high-level key disciplines, and the annual goals must be achieved, and the year-end evaluation by provincial experts.
Ye Shiyue, director of the Medical Department of the First Affiliated Hospital of Fujian Medical University, shared how to optimize the department indicators and empower the development of disciplines. Whether it is the assessment of the department or the performance appraisal of the dean, we must always use data to speak. Combined with the indicators of the development of hospital disciplines, combined with the indicators of national assessment, the development of each discipline should set corresponding clinical goals. The entire system covers hospital administrative related departments, outpatient departments, etc., and each functional department must come up with indicators and grasp the work around the indicators, so that there is a clear grip. For the construction of disciplines, it is necessary to have the characteristics of specialized disease treatment, and at the same time attach importance to MDT, and the number of cases of MDT is assessed every year. Hospital managers' management attitude towards disciplines is very important, extensive management can not find the characteristics of disciplines, horizontal and vertical all-round data interpretation and refined management, in order to truly empower the development of specialties.
Guo Zhijun, chief of the medical insurance department of the First Hospital of Quanzhou City, Fujian Province, analyzed the impact of medical insurance on the development of hospitals and specialties from the perspective of "three medical linkages". Since the "Sanming model" was launched nationwide, the impact of medical insurance policies on hospitals was unprecedented, and the implementation of certain measures has brought severe challenges to the development of hospitals and specialties. Of course, the content of medical reform includes the reform of medical insurance payment methods, performance appraisal of public hospitals, etc., and the design of many indicators actually hopes to promote the development of specialties.
Jin Zhaohui, deputy director of the Department of Clinical Pharmacy of West China Hospital of Sichuan University, said that the most important task of the pharmaceutical department is medical drug protection. Based on the national policy guidance and with the goal of better meeting the needs of clinical diagnosis and treatment, the hospital cooperates with the adjustment of the national medical insurance catalogue to carry out two new drug selection meetings every year, so that more urgently needed drugs for clinical diagnosis and treatment and urgently needed drugs for patients can enter the basic drug catalog of the hospital, and drugs with auxiliary drugs and less clinical needs are eliminated. This requires a high level of medication and management standards, and the entire pharmacist team needs to be continuously improved and empowered in terms of talent echelon construction and discipline professional development, so as to better ensure the safety, efficacy and compliance of patients. In addition, the high-quality development of disciplines should also use the platform of informatization and Internet + to implement reasonable chronic disease management, long prescriptions and other measures to benefit the people.
Empowering the emerging discipline of rheumatic immunology
Enhance the influence of the industry
Xu Jian, director of the Department of Rheumatology and Immunology of the First Affiliated Hospital of Kunming Medical University, pointed out that the Department of Rheumatology and Immunology started late and was relatively young, but each discipline was related to the Department of Rheumatology and Immunology, and it was urgent to enhance the influence of the Department of Rheumatology and Immunology in the industry. Many of the intractable diseases that have been found are rheumatism, but the disciplinary status of rheumatology and immunology is still easy to ignore, and one factor here is the case combination index (CMI) value. Due to the calculation method and ranking influence of the case combination index (CMI) value, the difficult and severe disease department may become an easy to diagnose department, and I hope to take this opportunity to call for a dialectical view of CMI value, establish a scientific discipline development and a bellwether for hospital development, and attach importance to rheumatic immunity, an emerging development discipline.
Mo Hanyou, director of the Department of Rheumatology and Immunology of the Affiliated Hospital of Guilin Medical College, stressed that the discipline construction of grass-roots hospitals should be strengthened from the aspects of medical treatment, teaching, scientific research, and party building. Rheumatology is not as much as there are many new technology updates like surgery, but in terms of scientific research, we have won the Guangxi Science and Technology Progress Award and Guangxi high-level talents, and there are still many directions of efforts in clinical and teaching, we plan to carry out chronic disease management as a sub-specialty, hoping to get the support of more experts, especially the support of rheumatology experts.
The conference was supported by Novartis Pharmaceuticals, Ms. Huang Xiaoyan, Director of The Department of Immunology, Liver and Dermatology of Novartis Pharmaceuticals, said that Novartis is committed to providing innovative drugs for Chinese patients, continuously strengthening cooperation with relevant parties in the medical industry, developing better medical solutions, jointly improving medical standards, helping the high-quality development of hospitals, and bringing positive impact to patients, the industry and society.
Text: Yu Wensu
Editor: Wang Zhengqing
Review: Han Lu