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霍勇:胸痛中心助力医改 重在基层

2017-08-13 齐金石 中国县域卫生

“胸痛中心不仅仅是急诊,急救的模式,更重要通过这种模式,对医疗体制的改革,将起到重要的推动作用。最后达到慢病筛查,急慢分治,资源下沉和分级诊疗。”8月11日,在2030道路与梦想圆桌论坛上,北京大学第一医院心内科主任霍勇教授介绍了成立胸痛中心的原因。

“胸痛中心不仅仅是急诊,急救的模式,更重要通过这种模式,对医疗体制的改革,将起到重要的推动作用。最后达到慢病筛查,急慢分治,资源下沉和分级诊疗。”8月11日,在2030道路与梦想圆桌论坛上,北京大学第一医院心内科主任霍勇教授介绍了成立胸痛中心的原因。

过去几年,在国家政策支持和疾病有关部门领导下,中国胸痛中心的建设发展初见成效。截至2016年12月,共有注册医疗机构1400家,有500家已经启动胸痛中心建设,有122家通过认证,其中有6家基层胸痛中心。胸痛中心的建设和规范化管理将极大促进其所在区域标准化诊疗的实施。

胸痛中心:让胸痛治疗链条更加顺畅

霍勇介绍,胸痛中心是一种全新的医疗管理模式,通过促进多学科的优势整合,对胸痛患者进行早期诊断、危险分层、正确分流及科学救治,从而提高急性冠状动脉综合征(ACS)、肺栓塞、主动脉夹层等危重症的救治效率。

“它更好地将院内和院前联系在了一起。”霍勇介绍了北大一院的例子,2012年,病人到了医院开通血管需要200多分钟,因为北大一院的急诊室到病房之间有500米,院内的二次转运没办法优化这个流程。2013年,医院实现了绕性急诊室,就是把病人从急诊室直接送到病房。仅此一条改善,就将时间从210分钟缩短到70分钟。“建立胸痛中心这种模式,通过整合资源,优化流程,提高效率。”

基层将会成为胸痛中心的建设重点

“所以在这种理念的推动下,我们建立了中国胸痛中心的标准。”霍勇介绍,胸痛中心并非全都是大医院,他们将胸痛中心分为标准版和基层版,基层版主要是指县级医院,尽管这些医院不能做主动脉夹层的手术,但是在建设过程中,医院的组织体系、救治能力、院前宣教等方面这方面都可以更加容易协调整合,提高效率。

目前为止,在国家卫计委和各个省的卫计委的支持下,已经有17个省建立了胸痛中心的联盟。此外,还有十几个省专门就胸痛中心的建设发了相关的文件,从2015年以后,天津、广东、湖北、江苏、新疆等地区创造了很多不同的模式。

“胸痛中心的建设本来就是医联体的模式,它是张网,让大医院和基层医院联系在一起。”霍勇认为,胸痛中心作为心脑血管急救的抓手,在区域内,所有的医疗机构和基层建立远程教育的网络,这也是胸痛中心的内涵建设。

“所以以胸痛中心建设为抓手,推动我们国家医疗体制的改革,我个人认为,是实现我们所谓的医联体,或者说分级诊疗的一个可行的路径,可以探索的一个路径。”霍勇说。

首先,胸痛中心的建设和国家分级诊疗的十六字方针,基层首诊,双向转诊,急慢分治,上下联动,理念上一致。胸痛中心也建立了协同的体系,这个体系使基层医疗资源的提升和优质资源的下沉,同时强调资源和优势互补。无论是基层首诊,还是延展到胸痛中心筛查、预防预防,社区里边能够更好的筛查出高危险人群的模式,达到基层首诊。

第二,双向转诊。比如急性心肌梗死的患者,基层医院需要转向大医院治疗,虽然不能在第一时间进行进一步的救治,但是可以第一时间点抗拴业务或者抗凝药物使用。

第三,充分利用资源。霍勇认为,分级诊疗中核心的是医联体能够整合资源,而且不需要增加太多资源的投入。

“这样的话,我相信,在医联体建设中间落实这十六字方针,能够为分级诊疗和胸痛中心的建设提供新的路径和模式。”

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    2017-08-27 虈亣靌

    继续学习中谢谢

    0

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    2017-08-15 tidiq
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    2017-08-15 xinmeili
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    2017-08-14 雅文博武

    学习了很多先进的医疗技术

    0

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    2017-08-13 1e0f8808m18(暂无匿称)

    胸痛中心,学习了。

    0

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    2017-08-13 大旺旺

    学习了啊

    0

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    2017-08-13 135****7952平儿

    学了。。。。。。。。。。

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=237746, encodeId=7c4123e746c5, content=继续学习中谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun Aug 27 18:24:25 CST 2017, time=2017-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286783, encodeId=278d1286e8364, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Tue Aug 15 00:45:00 CST 2017, time=2017-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1550856, encodeId=758015508564b, content=<a href='/topic/show?id=f41c9890585' target=_blank style='color:#2F92EE;'>#霍勇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98905, encryptionId=f41c9890585, topicName=霍勇)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e95214139028, createdName=xinmeili, createdTime=Tue Aug 15 00:45:00 CST 2017, time=2017-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233425, encodeId=fdba23342508, content=学习了很多先进的医疗技术, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Mon Aug 14 08:58:43 CST 2017, time=2017-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233181, encodeId=f6f4233181ae, content=胸痛中心,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sun Aug 13 14:44:17 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233180, encodeId=8088233180f9, content=学习了啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Sun Aug 13 14:35:05 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233156, encodeId=18dc23315637, content=学了。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Aug 13 11:38:55 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=233139, encodeId=f3cb233139de, content=基层医疗很重要的, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Aug 13 09:50:57 CST 2017, time=2017-08-13, status=1, ipAttribution=)]
    2017-08-13 flysky120

    基层医疗很重要的

    0

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