Construction Of Integrated Model Of Community Life Early Health Management

Objective: Take Hefei as an example to understand the health status of pregnant women and children aged 0-2 years within 1000 days of early life.Based on the theory of embryo origin and the concept of prevention,we should pay attention to the early life,and explore the more effective and cost-effective management in this stage;Based on the prevailing health problems in today’s society,especially the severe epidemic situation of chronic non-communicable diseases,a new health promotion and disease prevention path is explored.At the same time,we should promote the rational allocation of maternal and child health care resources,and alleviate the problems of insufficient and wasted health care resources in early life.Methods: The methods used in this study are as follows: 1)literature analysis: through reviewing the literature to the early life and maternal and child health care main contents and viewpoints are combed and summarized,to provide the theoretical basis and enlightenment for the model construction,including maternal and child health care policy,early life research,maternal and child service ability research and so on.2)case analysis: taking the early life health management of Hefei community as an example,the community health service center in its urban area was visited on the spot,specifically for the field investigation of 53 institutions’ child care departments,and the investigation of 47 institutions’ women’s protection departments.3)semi-structured interview: according to the outline of literature research and field visit design interview,one community was randomly selected in Hefei Shushan District,Luyang District,Baohe District and Yaohai District,and its experienced child care workers and women’s protection workers were selected for in-depth interviews to understand the current situation and shortcomings of the implementation of early life health management in grass-roots community health service institutions.4)inductive and speculative method:the results of early life health management,model construction and field visits and interviews collected in the early stage of life are summarized,which provides a theoretical and practical basis for this study.Then we use speculative method to distinguish and think about the contents of induction and summary,and put forward the health management mode of community integration.The quality is controlled by the following :1)obtaining the support of the health authorities;2)obtaining the informed consent of the community,recording the interview;3)visiting and interviewers with professional background,familiar with the study;4)the research leaders overall control,timely communication.Results: 1)health management content of 1000 days in the early life can be summarized into four dimensions: physical health management,mental health management,nutrition management,health education.Physical health management includes birth examination,vaccination,disease screening,etc.;mental health management includes psychological management during pregnancy,prenatal and postnatal psychological guidance,children’s psychological and behavioral development,etc.;nutrition management includes maternal dietary balance,nutrient supplement,newborn breastfeeding,supplementary food addition,etc.;health education runs through the early life of 1000 days management,including policy knowledge education,fetal growth and development,behavior education,etc.2)47 community health service centres were provided with pregnancy tests: routine blood and urine tests,blood type tests,hepatitis B five tests,HIV antibody tests,47 communities were able to provide the lowest rate of pelvic identification and fetal heart monitoring,17.02% and 29.79%,respectively,and 5 institutions were able to provide thyroid tests,2 ECG tests,1 folic acid test and 1 community was able to provide TORCH tests.For reasons why inspection projects could not be provided(multiple selection),33 communities considered lack of qualifications,16 communities lacked equipment,and 4 communities said they did not have inspection skills A skilled man.Blood routine examination and growth and development assessment of infants and young children in 53 community health service centers were available,and the rate of hearing screening and visual screening was low,15.10% and 47.17%.For reasons why inspection projects could not be provided(multiple selection),39 communities were not equipped,16 communities considered to be unqualified,and 7 communities said they were not equipped with inspection techniques.3)interview results: in the early life management of community health service center,there are stages of fragmentation,including child protection,postpartum visit,vaccination,health care content fragmentation,information management scattered,insufficient resources and waste of resources.In particular,maternal and child health care should have been integrated,but although the Maternal and Child Health Manual was successfully issued in Anhui Province and implemented only as self-study and monitoring for pregnant women,Hefei still uses the Maternal Health Manual and the Child Health Manual separately at this stage;while child health care and child vaccination should be integrated,the vaccination services of the Hefei Community Health Service Centre are independent,and vaccination is the responsibility of a special person other than the child health care,and lack of contact and communication with the child care department;post-natal visits and neonatal visits are generally completed by specialized visitors,as well as maternal and child health care Open it.In general,the visiting staff are mainly nurses,the results of the visit are managed independently,and the mechanism and channels of communication with child and women’s insurance are lacking;because many health care contents,especially during pregnancy and childbirth,can be done by many medical institutions,the birth examination of a pregnant woman may exist in the community health service center in the early stage,the mid-term Tang sieve and so on in the maternal and child health care hospital,and in the later stage because of the situation of the birth examination in the third Class A General Hospital in the near labor period.The community health service center of Hefei has basically popularized the electronic information retention,but there is a problem of obvious information system breakage,which can not be shared,forming an information island.Health care tasks are heavy,and some communities are more accountable and urgent It is hoped that more people will share the work;some communities provide certain services such as routine testing,but the testing resources are not fully utilized because of the residents’ distrust of the community or some other reason to choose to go to other medical institutions for testing.4)construct the "community-based,designated referral,information exchange early life full integration model ",the model includes community health service institutions,non-community medical institutions,health care object three participants;two supporting technologies:information management system and early life health management guidelines.Conclusion: The integrated model of early life health is to explore the first diagnosis and integrated medical treatment in the community,but also to provide a new way of thinking for disease prevention,hoping to start from the early life,start from the community,lay a good foundation for health,reduce the number of hospital admission from the source,improve the level of maternal and child health care,and ensure the health status of residents.However,there may be problems of lack of human resources,low cooperation of relevant institutions and free choice of demanders,so we should carry out human resources construction,regional support and publicity,education and system regulations for the demanders.