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.
Stroke, Integrated Care, Qualitative Research
Public Policy and Public Perspectives on Aging
Research Assistant, Health Policy Research, Shanghai Health Development Research Center, China
Shanghai Health Development Research Center, China
Li Fen is a research associate in Shanghai Health Development Research Center, the director of Division of Health Financing and Planning Research. Li Fen’s research primarily focuses on health financing, hospital management, whose mechanism has great impact on health outcome. National Health Accounts is one of the main research fields of health financing. Li Fen engaged in health expenditure accounting of Shanghai from 2008 to 2015 under the framework of MOH (Ministry of Health of PRC). From Feb to Aug in 2013, Li Fen worked in the department of Health System Financing, World Health Organization(WHO, Geneva). Li Fen has been the primary investigator of more than 10 research projects, published over 20 papers. The research projects she involved had awarded Silver Prize of East China Science & Technology Information Achievements in 2014, and ward of Excellent Outcomes in Chinese Health Economics Association twice.
Research Assistant, Shanghai Health Development Research Center (Shanghai Medical Information Center), China
Research Assistant, Department of Health Policy Research, Shanghai Health Development Research Center, China
Director , Shanghai Health Development Research Center, Shanghai Health Development Research Center, China