Wafangdian City, Liaoning Province Achieves Remarkable Success with 'Tight-knit Medical Consortium' as a Breakthrough in County-level Integrated Healthcare Reform

On May 31, 2019, the Leading Group for Deepening the Reform of the Medical and Healthcare System of Liaoning Province issued the "Two-Year Action Plan for 'No Major Diseases Leaving the County' in Liaoning Province (2019-2020)." In the work plan for implementing pilot programs for comprehensive medical and healthcare reform at the county level, it was stated that "the service delivery system should be integrated to establish county-level medical communities, and efforts should be encouraged to learn from and draw on the model of Wafangdian City in Dalian." Meanwhile, the document designated Wafangdian City, Dalian, as a pilot area for comprehensive county-level reform under the 2019 "No Major Diseases Leaving the County" Action Plan.

Wang Guifen, Director of the Liaoning Provincial Health Commission, led a team to Wafangdian City in July to hear reports on the development of the compact county-level medical consortium. After conducting field research, Director Wang fully affirmed the achievements made in the reform of public hospitals in Dalian and the construction of the compact county-level medical consortium in Wafangdian City.

It is reported that, as a pioneer in the healthcare reform of county-level public hospitals, Dalian Wafangdian Central Hospital (hereinafter referred to as “the Central Hospital”) took the lead in integrating 10 township health centers and 110 village clinics as early as 2017 to establish an integrated and closely-knit medical consortium. With the support of SENYINT, it has formed a healthcare service system featuring interconnected information and coordinated operations, thereby optimizing the allocation of medical resources across the city.

Currently, the city has established a three-tiered county-level medical service system linking municipal, township, and village levels, with central hospitals as the lead, township health centers as hubs, and village clinics as the foundation. A preliminary framework for tiered diagnosis and treatment and two-way referrals has been formed across the city. Primary healthcare capabilities and the development of medical and nursing personnel have been significantly strengthened, providing the public with equitable, accessible, systematic, and continuous basic medical care and essential public health services.

According to the Dalian Daily, prior to the implementation of the tiered diagnosis and treatment system, township health centers in Wafangdian did not perform surgeries, had no inpatients, recorded extremely low outpatient volumes, and received poor satisfaction ratings from residents. Following the establishment of the tiered diagnosis and treatment system, the total number of consultations at these township health centers increased by 64.3%. Common conditions such as cor pulmonale, cerebral infarction, and coronary heart disease can now be diagnosed and treated at the health centers, earning widespread approval from local residents. Some township health centers have sequentially introduced surgical services, performing over 100 procedures including total thyroidectomy, total hysterectomy, and appendectomy. Before the implementation of the tiered diagnosis and treatment system, fewer than ten qualified physicians were employed across Wafangdian’s township health centers; currently, licensed physicians account for 60% of the medical staff, with an average of one associate senior physician and more than four attending physicians per health center. Through substantial investments in enhancing the capacity and quality of three-tier healthcare services at the county, township, and village levels, residents of Wafangdian City can access high-quality diagnostic and treatment services close to home at minimal cost, thereby experiencing a growing sense of benefit and satisfaction.

Leveraging medical cloud technology, the City Central Hospital has established a multi-tiered collaborative telemedicine platform with the First Affiliated Hospital of Dalian Medical University, as well as 23 renowned hospitals in Beijing and 22 in Shanghai. This initiative has enabled significant advancements: the Stroke Center and Chest Pain Center have successively obtained provincial certification; the construction of the Trauma Center, Medical Imaging Consultation Center, and Clinical Laboratory Center ranks first among all districts, counties, and cities; and cardiac intervention, peripheral vascular intervention, and the diagnosis and treatment of vascular surgical diseases continue to lead among county-level hospitals in the northern districts and cities. Over 100 experts have been paired with community health centers for outpatient services, and 20 experts have established studios at these centers, effectively alleviating the public’s difficulty in accessing medical care. Scheduled, fixed-point consultations with specialists at community health centers have become a new diagnostic and treatment model for rural residents.

With the support of the Municipal Central Hospital, township health centers have continuously strengthened their information technology infrastructure. All health centers have newly installed Hospital Information Systems (HIS), Laboratory Information Systems (LIS), Electronic Medical Record (EMR) systems, and teleconsultation systems, including remote medical imaging diagnosis, electrocardiogram (ECG) diagnosis, and ultrasound remote diagnosis systems. Within the medical consortium, DR images, ECGs, and selected ultrasound examinations are transmitted remotely to the main hospital for centralized diagnosis. This approach not only enhances the diagnostic capabilities of township branch hospitals but also prevents the underutilization of professional personnel.

Currently, all laboratory equipment at township health centers has been fully integrated with the information platform. Patients can undergo imaging examinations either at their bedside or at local hospitals near their homes, with the data transmitted in real time to the imaging center of a higher-level hospital. There, attending physicians or senior specialists from the central hospital perform the diagnosis and prepare the reports. Once reviewed, the diagnostic results are instantly returned to the township health center. This model delivers diagnostic and treatment services of equivalent quality while reducing medical costs by more than 15%.

Meanwhile, the City Central Hospital is actively building an interconnected diagnosis and treatment information platform, gradually implementing the county-township integrated “Smart Cloud Platform,” and opening up information exchange channels between the hospital and community health service centers. This enables rational allocation of medical resources and patient triage, truly making community hospitals “hospitals at residents’ doorsteps.”

After integrating the community health service information systems, members of the Wafangdian Medical Consortium achieved sharing of residents' electronic health records, providing valuable foundational data for functional departments such as maternal and child healthcare, chronic disease management, and infectious disease control. The interconnectivity of medical institution information data within the region not only reduces the financial burden on patients and alleviates difficulties in accessing medical care, but also enables health administrative authorities to implement top-down networked management, standardize diagnosis and treatment processes, and effectively supervise and manage basic public health services and essential clinical services.

Currently, Wafangdian City has initially established a tiered diagnosis and treatment framework with bidirectional referral mechanisms. Its “Medical Community” management system was recognized as one of the “Top Ten Livelihood Projects in Wafangdian City in 2019.” Through integrated management of primary healthcare institutions, the Municipal Central Hospital has enabled remote diagnostics, remote consultations, unified quality control standards, and mutual recognition of examination and test results. These measures have effectively promoted the implementation of a tiered diagnosis and treatment system characterized by initial consultations at primary care facilities, bidirectional referrals, separate management of acute and chronic conditions, and coordinated care between upper- and lower-level institutions. Since the implementation of the bidirectional referral program, over 1,000 patients have been referred between different levels of care. Outpatient visits at township health centers have increased by 32%, and hospital admissions have risen by 17%, marking the initial formation of a tiered diagnosis and treatment pattern.

In the future, Wafangdian Central Hospital will partner with SENYINT to upgrade smart healthcare services, providing unified cloud-based IT solutions for 10 township health centers. This initiative aims to gradually achieve centralized financial management and pharmaceutical distribution, foster collaborative development among medical consortium members, facilitate the decentralization of medical resources, and improve healthcare access for grassroots communities.