Aging & Social Change: Ninth Interdisciplinary Conference

Abstract

Facing the increasing morbidity and mortality caused by stroke, Shanghai started to build a network in 2012 to prevent and treat stroke. The network consists of eleven municipal hospitals, twenty-five district hospitals and 240 community health centers. We identify experiences and lessons learned from practices of the network. Method are qualitative research and thematic analysis of data. Three themes were identified through analysis: (1) Integration of services: services of different facilities have been re-formed and vertically integrated through treatment and referral standards. A risk stratification scale based on ABCD scores (validated predictors of stroke) is adopted by community health centers to proactively identify population at higher risks. These individuals are referred to district hospitals to receive further screening. District hospitals are responsible for early thrombolysis and rehabilitation of diagnosed patients, and referral services to municipal hospitals. (2) New roles and skills: Municipal hospitals concentrate on high complexity care and emergency rescue services for acute onset stroke. They provide technical assistance and training to lower level institutes regarding neurosurgery, vascular surgery and TCM rehabilitation. Community health centers focus on health management of high risk individuals, secondary prevention and rehabilitation of stroke patients. (3) Incentives and payment: Operation of the network largely relies on administrative regulations. An evaluation system and payment mechanisms are in need to incentivize the health workforces to fulfill their responsibilities and to ensure performance of the network. Treatment capacity and service homogeneity of stroke have been enhanced among different facilities, enabling patients to receive continuous services.