This year marks the fifth anniversary of the proposal of the "People's City" concept. As the birthplace of this concept, Yangpu is witnessing the vigorous development of the digital economy and the vibrant pulse of life. Let's experience this increasingly "YOUNG" People's City together...

August 19 is Chinese Doctors' Day. In the new practice of the "People's City," continuously enhancing the well-being of the people, medical benefits for the people have always been a focus of attention. "Promoting the expansion and sinking of high-quality medical resources" has undoubtedly been the development direction of Shanghai's medical and health services in recent years.

A visit to the doctor "at the doorstep" became a "turning point" for getting rid of a 30-year-old ailment—suffering from back pain, she "saw" an expert at the community health service center near her home. "It was your professionalism and patience that allowed me to regain the courage and hope for life"; a specially "troubled" student found a warm "medical support" at the insomnia clinic—facing patients anxious due to insomnia, the doctor offered comfort, "After hearing the doctor's explanation, I felt the stone in my heart had been lifted"; the "golden fruit" of public hospital development was transformed into a sense of gain for residents seeking medical treatment—the Yangpu District Public Hospital Performance Appraisal Indicator Data Analysis Report released this year shows that the overall medical service volume in the district has significantly increased, the proportion of level-four surgeries has grown, and the service capacity has steadily risen...

In the "People's City," the people come first. "Precision" and "universal benefit" have never been a pair of contradictions. In our district, how are medical resources "optimally applied" to allow residents to more conveniently obtain higher-quality services?

A Visit to the Doctor "at the Doorstep" Became a "Turning Point" for Getting Rid of a 30-Year-Old Ailment

Recently, a heartwarming scene unfolded at Shanghai First Rehabilitation Hospital—Ms. Wang and her husband braved the high temperature to present a silk banner to Sun Tianbao, director of the Rehabilitation Department, to express their gratitude. "It was your professionalism and patience that allowed me to regain the courage and hope for life," Ms. Wang said, holding the doctor's hand, somewhat emotionally.

"For a long time, lying in bed was my daily life. Whether it was lying on my side, getting up, getting dressed, standing, or walking, it all became increasingly difficult." In the past, Ms. Wang, who lives in the Yanji New Village Community, suffered from back pain, and a visit to the doctor "at the doorstep" became a "turning point."

Two years ago, 64-year-old Ms. Wang suddenly developed S-shaped scoliosis and lumbar disc herniation. Accompanied by her husband, Ms. Wang sought medical treatment everywhere, trying various Chinese and Western therapy methods and running around various secondary and tertiary hospitals. Due to Ms. Wang's large degree of scoliosis, which was close to 40 degrees, the effect of conservative therapy was very limited, but her health condition had not reached the conditions for surgery. For a time, Ms. Wang was caught in a dilemma.

In unbearable pain, Ms. Wang came to the Yanji Community Health Service Center for physiotherapy with a mindset of giving it a try. At that time, Shanghai had just introduced new policies for hierarchical diagnosis and treatment, and the city comprehensively implemented the priority opening of outpatient appointment sources from secondary and tertiary hospitals to community health service centers. Here, she met Sun Tianbao, director of the Rehabilitation Department of Shanghai First Rehabilitation Hospital, who was seeing patients in the community.

Sun Tianbao conducted a comprehensive assessment for Ms. Wang and found the root cause of her scoliosis. It turned out that more than 30 years ago, Ms. Wang had experienced postpartum pelvic sacroiliac joint dislocation. "Although there were no symptoms in the early stage, this dislocation changed the biomechanics of the spine, indirectly leading to the formation of S-shaped scoliosis in Ms. Wang's later years." After clarifying the cause, Ms. Wang was referred through her family doctor to Shanghai First Rehabilitation Hospital for further treatment.

Here, an expert team formulated a dynamic rehabilitation therapy plan for Ms. Wang, targeting different trainings at different stages. In the early stage of rehabilitation, the focus was on joint reduction, joint mobilization, and fascia release. In the middle stage, it was necessary to do exercises, train endurance, and improve cardiopulmonary function. In the later stage, guidance was provided for bad habits in life to prevent recurrence. "We assess and solve the patient's problems as a whole, not just treating the head when the head hurts and the feet when the feet hurt," Sun Tianbao said.

With the simultaneous support of basic physiotherapy at the community health service center, over the past few months, from initially being in unbearable pain to being able to walk freely, and then going out shopping with her husband, Ms. Wang's condition has significantly improved, and her life has undergone a tremendous change.

The sinking of appointment sources and precise triage are to allow precious medical resources to achieve "optimal application." The relevant person in charge of the Medical Affairs Department of Shanghai First Rehabilitation Hospital introduced that "experts from tertiary and secondary hospitals going to the community" is an effective measure to refine and advance the "sinking of appointment sources," allowing family doctors and patients to understand the specialty characteristics and professional strengths of tertiary and secondary hospitals, better selecting suitable medical services and reducing information gaps. On the one hand, patients can make "expert appointments" at their doorstep, greatly solving the difficulty of long-distance medical treatment and improving the accessibility of medical resources. On the other hand, compared to patients' self-assessment and "seeking medical treatment," referrals by family doctors based on the patient's condition are more "precise." Subsequent treatment or routine treatment can then return to the community health service center, realizing the virtuous cycle of medical resources.

Specially "Troubled" Students Find Warm "Medical Support" at the Insomnia Clinic

About one-third of a person's life is spent sleeping, and adequate sleep is one of the three major health standards recognized by the international community. However, sleep problems now trouble many people.

The insomnia clinic at Changhai Hospital has been open for 5 years, and patients seeking consultation for sleep problems have been coming in an endless stream.

"After hearing the doctor's explanation, I felt the stone in my heart had been lifted." Grandma Zhang (pseudonym) has often had trouble sleeping well over the past year, with difficulty falling asleep at night, constant nightmares, and lack of energy during the day, so she came here for treatment. Facing the anxious Grandma Zhang, neurologist Zhao Xiangxiang offered comfort, "This situation is very common among the elderly and there's no need to worry too much. Don't take insomnia too seriously."

Zhao Xiangxiang gave adjustment suggestions for Grandma Zhang's daily routines, exercise, and other habits. He said that some people misunderstand or exaggerate the consequences of insomnia. Many patients go to bed early shortly after dinner, tossing and turning. When drowsiness is slow to come, they become depressed, anxious, and discouraged.

During our interviews, we learned that among the patients seen in the insomnia clinic, the most common are those with anxiety-induced insomnia like Grandma Zhang. For such patients, doctors provide more psychological counseling, such as guiding patients to write sleep diaries, helping them correct sleep cognition, and forming good sleep habits.

In fact, apart from physical reasons, a large part of sleep problems are caused by psychological factors. In addition to specialized insomnia clinics, citizens can also consult doctors in relevant departments such as the psychology department and psychosomatic department of regular hospitals.

Waking up in the middle of the night and having difficulty falling back asleep, having tried various supplements and health products without good effect; feeling lethargic during the day, often with headaches and dizziness... 65-year-old Ms. Liu has been troubled by sleep problems for more than a year and came to the psychology department of the district central hospital for treatment, accompanied by her daughter. Ms. Liu's daughter said that her mother used to be full of energy, not only buying groceries and cooking but also often going out to dance in the square and volunteering at the neighborhood committee. Now she's even too lazy to go out.

After careful inquiries, the doctor learned that Ms. Liu had suffered economic losses due to an investment and felt very guilty, which led to the onset of sleep problems. After psychological counseling from the doctor and taking some medications to adjust her mood and help with sleep, Ms. Liu's sleep situation greatly improved after two weeks, and her mood gradually began to improve as well.

When facing insomnia, many people's first thought is to take sleeping pills, but it's not that simple. Sleep problems involve both the body and mind. If one is a specially "troubled" student, then one needs to "sleep" in the hospital.

"When I heard the command 'charge' while sleeping, I charged out and ended up hitting my shoulder on the doorframe. I got more than a dozen stitches here," Mr. Gao (pseudonym) said, troubled as he recounted his experience to the doctor at the insomnia clinic of Changhai Hospital.

After preliminary diagnosis, the doctor suspected that Mr. Gao had rapid eye movement sleep behavior disorder and suggested that he "sleep" in the hospital at night for a polysomnography. "Polysomnography mainly assesses the patient's sleep situation through electroencephalogram, electromyogram, eye movement conditions, blood oxygen, snoring, leg movements, etc., and then provides a comprehensive plan to improve sleep," explained Bi Xiaoying, director of the Department of Neurology at Changhai Hospital. "When normal people dream, their whole body muscles are relaxed, so no matter what they dream of, they can't move. But if rapid eye movement sleep behavior disorder occurs, the muscles still have strength when dreaming, and they will do whatever actions they dream of, which is very dangerous."

In addition, acute insomnia and chronic insomnia are distinguished by a boundary of 3 months. Zhao Xiangxiang said that patients with acute insomnia generally have relatively clear triggers, while for patients with chronic insomnia, further assessment is needed. "We will conduct a relatively comprehensive assessment of anxiety and depression scales, and then see if medication needs to be given for synchronous therapy."

The "Golden Fruit" of Public Hospital Development Transforms into Residents' Sense of Gain in Seeking Medical Treatment

Currently, our district has 8 district-owned public secondary and tertiary hospitals, including 1 tertiary Grade B hospital, 2 secondary Grade A hospitals, and 1 each specializing in traditional Chinese medicine, rehabilitation, mental health, dental prevention, and geriatric nursing. Allowing residents to see a doctor, receive good treatment, make fewer trips, and spend less money is the endeavor direction of high-quality development for Yangpu's public hospitals.

In the Yangpu District Public Hospital Performance Appraisal Indicator Data Analysis Report released this year, a set of data outlines the results of public hospital reform and high-quality development.

In response to the shortcomings such as "outpatient patient satisfaction" in the previous year, the District Central Hospital (Yangpu Hospital Affiliated to Tongji University) launched an excellent service special action plan to improve the level of intelligent medical treatment and enhance patients' medical experience. At the end of 2023, the new comprehensive building of the District Central Hospital was officially put into use, greatly improving problems such as insufficient space and incomplete configuration of large-scale equipment, further raising the service level.

Over the past year, the proportion of level-four surgeries at the Yangpu Central Hospital increased from 15.55% to 21.16%, and the proportion of minimally invasive surgeries increased from 18.65% to 21.96%; the proportion of medical service revenue increased by 0.97%, reaching a high of 26.68% at the end of the year; the proportion of drug expenses decreased by 2.82%; and the average outpatient and inpatient drug expenses decreased month by month.

As the medical center of the northern region of our district, the Municipal East Hospital has carried out the construction of new multidisciplinary joint diagnosis and treatment (MDT) centers on the basis of the existing ones; signed a collaboration agreement with Changhai Hospital to gradually jointly appoint directors of some weak disciplines and improve specialty skills. After the collaboration in the orthopedics department, both the bed utilization rate and the surgery rate have increased.

The Municipal East Hospital has given full play to the function of the medical alliance, realizing two-way referrals with medical alliance units—community health service center physicians can make online appointments for magnetic resonance imaging, CT, gastrointestinal endoscopy, and other examinations; CT and film imaging transmission and remote reporting have been achieved with Changhai, Siping, and Wujiaochang community health service centers.

Kongjiang Hospital has taken the lead in establishing the "Medical Care, Nursing, and Health" medical alliance for geriatric medicine in Yangpu District, signing contracts with 8 surrounding nursing homes. Through services such as technology training, specialty consultation, technology assistance, and research guidance, it helps promote the homogeneous development of nursing institutions in our district.

Using the "Yangpu-Changhai" medical alliance led by the District Health Commission as a carrier, Kongjiang Hospital has continuously promoted the construction of stroke centers, chest pain centers (grassroots version), critical children and neonatal treatment centers, and trauma centers (grassroots version).

In addition, Kongjiang Hospital is preparing to establish a regional palliative care center, exploring the formation of a Yangpu-characteristic palliative care center model; establishing a district visual health center, constructing a district visual health standardized diagnosis and treatment center, planning the construction of a district visual health prevention and intervention center, and building a comprehensive service management system for visual health in Yangpu District.

Patient and physician satisfaction is the ultimate goal of high-quality development in public hospitals. In the next step, our district will combine the characteristics of relevant specialty hospitals to set different indicators and weights, further improving the targeting and precision of assessments; study and formulate performance appraisal indicators for medical alliances and regional medical service systems to promote hierarchical diagnosis and treatment and the optimal allocation and effective utilization of medical resources, and improve the fairness and accessibility of services; build a higher-level information platform to ensure accurate and objective monitoring and assessment indicator results, continuously transforming the development results of public hospitals into residents' sense of gain in seeking medical treatment.