On January 4, 2022, the National Health Commission issued the national eye health plan for the 14th five year plan (2021-2025) (gwyf [2022] No. 1, hereinafter referred to as the plan) to continuously promote the high-quality development of China's eye health during the 14th five year plan. The National Health Commission interprets the plan as follows:
1、 Why did the plan come out?
The CPC Central Committee and the State Council attach great importance to eye health. Since the 1980s, the national level has continuously issued plans for blindness prevention and treatment and eye health, defined the main tasks and measures at different stages, and continuously improved the eye health management system, technical guidance system and service system. During the 13th Five Year Plan period, China has made remarkable achievements in the field of eye health, and the age standardized prevalence of blindness has been lower than the global average. *** The outline of the "healthy China 2030" plan clearly requires that we continue to carry out blindness prevention and treatment. However, the problems of insufficient total and uneven distribution of ophthalmic medical resources still exist in China, and the work of eye health has a long way to go. The introduction of the plan will help to promote the high-quality development of eye health during the 14th Five Year Plan period.
2、 What are the guiding ideology and basic principles of the plan?
*** Further build a high-quality and efficient eye health service system and strive to provide people with eye health services covering the whole life cycle. During the 14th Five Year Plan period, promoting the high-quality development of eye health should follow the basic principles of "three insistences and two emphases", that is, adhering to the overall planning and resource integration, adhering to the high-quality development of improving quality and efficiency, adhering to the combination of prevention and control, and focusing on key populations and key eye diseases.
3、 What are the tasks and specific objectives of the development of eye health in China during the 14th Five Year Plan period?
During the 14th Five Year Plan period, efforts were made to strengthen the construction of ophthalmic medical service system, capacity and talent team, continuously improve the ophthalmic medical quality control system, and promote the expansion and extension of high-quality ophthalmic medical resources. We should effectively promote the prevention and control of children's myopia and scientific correction, further enhance the ability of cataract rehabilitation, and gradually improve the screening ability of primary health care institutions for diabetic retinopathy and other diseases, so as to promote the orderly development of corneal donation. By 2025, we will strive to achieve the following goals: first, the annual coverage of eye health care and visual examination for children aged 0-6 years will reach more than 90%, and the overall level of eye health of children and adolescents will continue to improve. Second, the coverage of effective ametropia correction has been continuously improved, and the number of visual damage caused by high myopia has been gradually reduced. Third, the cataract surgery rate of one million people in China has reached more than 3500, and the effective cataract surgery coverage has been continuously improved.
4、 How to further promote the development of China's ophthalmic medical service system during the 14th Five Year Plan period?
During the 14th Five Year Plan period, in order to promote the high-quality development of China's ophthalmic medical service system, we should focus on the following aspects: first, strengthen the construction of Ophthalmology and ophthalmic specialized hospitals in general hospitals, gradually establish and improve the national regional provincial municipal County five-level ophthalmic medical service system, and optimize the layout of medical resources. Build a highland of Ophthalmology medicine, give play to the technical guidance and radiation driving role of each center, and improve the overall service capacity of Ophthalmology. Build an eye health service network suitable for China's national conditions, provide comprehensive, fair and accessible eye health services, and strengthen the construction of ophthalmic medical service system. Second, improve the ability of ophthalmic medical services, focus on children and elderly patients, and focus on improving the ability of scientific correction of myopia, cataract surgery and common eye disease screening. Improve the efficiency of ophthalmic medical services and build a "separation of urgency and slowness" model. Strengthen the construction of grass-roots service capacity, and promote the application of effective vision screening and fundus screening technology at the grass-roots level. Strengthen the implementation of the requirements for the combination of prevention and treatment, establish a working mechanism for the combination of medical treatment, prevention and rehabilitation of ophthalmic diseases, and provide patients with continuous diagnosis and treatment services of screening, diagnosis, treatment and follow-up. Third, optimize the team of ophthalmic professional and technical personnel, strengthen the training and training of ophthalmic medical personnel, and form a stable and reasonable echelon of ophthalmic professionals. Strengthen the standardized training of ophthalmic residents and further improve the connection mechanism between the standardized training of ophthalmologists and professional title promotion. Strengthen continuing medical education and training to improve the clinical technical ability and level of ophthalmologists. Fourth, standardize clinical diagnosis and treatment behavior, strengthen ophthalmologists' awareness of practicing according to law, strictly implement the core system of medical quality and safety, and ensure medical quality and safety. Strengthen the construction of ophthalmic medical quality management and control system to improve the level of ophthalmic medical quality.
5、 How to strengthen the prevention and treatment of eye diseases during the 14th Five Year Plan period?
During the 14th Five Year Plan period, we should strengthen the prevention and control of eye diseases from the following aspects: first, fully implement the implementation plan for comprehensive prevention and control of myopia among children and adolescents and the appropriate technical guide for prevention and control of myopia among children and adolescents, and promote the prevention and control of myopia among children and adolescents. Guide medical institutions to implement the requirements of the guidelines for myopia prevention and treatment, promote scientific myopia correction, and improve the level of myopia prevention, control and correction. Second, promote the sinking of cataract surgery technology and improve the ability of cataract surgery in county hospitals. Guide medical institutions to standardize cataract surgery, strengthen operation quality management, establish and improve postoperative follow-up system, and improve effective cataract surgery coverage. Third, promote the early detection, early diagnosis and early treatment of eye diseases such as fundus diseases and glaucoma, and improve the management mode of patients with chronic eye diseases. Promote the construction of Ophthalmology related medical associations, and promote the gradual coverage of fundus photography screening technology. Promote the implementation of the "thousand county project", build a chronic disease management center of county-level general hospitals, build an eye disease management system, and improve the ability of early diagnosis and treatment of eye diseases such as fundus diseases and glaucoma. Fourth, reasonably plan and standardize the construction of eye bank, and standardize the acquisition, treatment, preservation and use of donor cornea. Pay attention to the construction of talent team and relevant technical training, strengthen the clinical application management of corneal transplantation technology, implement the whole process quality control of corneal transplantation, and improve the treatment ability of corneal blindness. Fifth, consolidate the achievements in eliminating blinding trachoma, improve the treatment level of eye diseases such as neonatal eye diseases, oblique amblyopia, eye surface diseases, orbital diseases and eye trauma, and strengthen the diagnosis and treatment services of genetic eye diseases.
6、 During the 14th Five Year Plan period, what eye health support platforms should be strengthened?
In order to provide high-quality eye health services, we should do a good job in the construction of the following five support platforms: first, strengthen the construction of eye health service platform for children aged 0-6, implement eye health care and visual examination for children aged 0-6 in combination with national basic public health services, and build a child eye health service network with division of labor, emphasis and close cooperation, Early screening of common eye diseases in children and correction of poor vision. Second, strengthen the construction of low vision diagnosis, treatment and rehabilitation platform, continuously improve the setting rate of low vision clinics in ophthalmology and ophthalmic specialty hospitals of tertiary general hospitals, and improve the referral mechanism between ophthalmic medical institutions and low vision rehabilitation institutions. Three, we should strengthen the construction of eye health information platform, actively promote the application of "Internet plus" medical service mode in Ophthalmology, and utilize the information technology such as Internet diagnosis and treatment, telemedicine, and so on to enhance the accessibility of ophthalmic medical services. Fourth, strengthen the construction of eye health science popularization platform, establish and improve public welfare eye health science popularization knowledge base and science popularization platform, take "paying attention to universal eye health" as the main line, and focus on time nodes such as national eye love day and world vision day to strengthen eye health science popularization. Five, we should strengthen the construction of eye health science research platform, strengthen the clinical diagnosis and treatment technology innovation and application research, promote the transformation, popularization and application of research results, and strengthen epidemiological studies on key eye diseases, and monitor the prevalence, incidence rate and disease spectrum of major blindness eye diseases in China.
Expert interpretation I
Strengthen the construction of eye health platform
Do a good job in the prevention and treatment of key eye diseases in key populations
Beijing Tongren Hospital Affiliated to Capital Medical University
Ning Li Wang
Eye health is an important part of physical and mental health, involving the whole life cycle of all age groups, and a major public health and social problem related to people's livelihood. The national eye health plan for the 14th five year plan (hereinafter referred to as the plan) was issued at the right time, which is of great practical significance for promoting the high-quality development of China's eye health cause and improving the people's eye health level during the 14th Five Year Plan period.
1、 Focus on children, adolescents and the elderly
Research shows that uncorrected ametropia and cataract are the top two blinding eye diseases in China. Children, adolescents and the elderly are the most vulnerable to these two eye diseases in the whole age group. During the 14th Five Year Plan period, China's eye health work focused on these two groups of people, which played a vital role in improving the level of eye disease prevention and treatment in China.
In terms of myopia prevention and control, China incorporated myopia prevention and control into government performance assessment during the 13th Five Year Plan period, forming a good atmosphere of "government leadership, department cooperation, expert guidance, school education and family attention". The establishment of Ophthalmology related courses and the training of ophthalmologists and optometrists have helped to build a professional team. During the 14th Five Year Plan period, on the basis of improving service accessibility, further attention was paid to the improvement of service quality. The concept of effective refractive correction coverage (Erec) is clearly used to measure the coverage and quality of refractive correction services.
In terms of cataract prevention and treatment, by 2020, the cataract surgery rate (CSR) of one million people in China has exceeded 3000, an increase of nearly 38 times in 30 years. During the 14th Five Year Plan period, the measures in the plan to improve the ability of cataract surgery will effectively ensure that the ability of county hospitals to carry out cataract surgery will be greatly improved, and the CSR will reach more than 3500. In addition, the plan emphasizes the need to strengthen the management of operation quality and postoperative follow-up, and continuously improve the effective cataract operation coverage (ECSC).
2、 Clearly improve the level of myopia prevention, control and correction
*** The state has continuously formulated and issued the implementation plan for comprehensive prevention and control of myopia among children and adolescents, the guidelines for prevention and control of myopia and the appropriate technical guidelines for prevention and control of myopia among children and adolescents to guide all localities to carry out myopia prevention and control.
Myopia prevention and control should move forward. The plan emphasizes the need to strengthen eye health care and vision examination services for preschool children aged 0-6, advocate prevention first, strengthen the body and prevent myopia, encourage ophthalmologists to enter the campus for science popularization and carry out Health Month activities for primary and secondary school students. We will adhere to the guidance of the government, multi sectoral cooperation and the participation of the whole society, strive to achieve 100% coverage of myopia monitoring in counties (districts) across the country, and form a vision health standard system for children and adolescents. For children and adolescents who have myopia, scientific optometry is emphasized. Improve the ability of early diagnosis and prevention and control of myopia and strengthen the scientific correction of myopia, so as to delay the progress of myopia and avoid secondary injury caused by improper use of products; Those who have developed high myopia should implement intervention measures as soon as possible to reduce disability and blindness. In the process of developing myopia correction services for children and adolescents and myopia surgery for adults, medical institutions at all levels should strictly abide by clinical application norms to ensure medical quality and safety.
3、 Clarify the meaning of Erec and ECSC
In 2020, the World Health Organization put forward the 2030 global eye health goal. It is proposed that countries with 40% increase in Erec and 60% or higher baseline effective coverage by 2030 strive to achieve universal coverage; Countries with a 30% increase in ECSC and a baseline effective coverage rate of 70% or higher should strive to achieve universal coverage.
Erec and ECSC can monitor the scope and quality of eye health services worldwide. They can not only reflect the accessibility of cataract surgery and refractive correction services in a certain population, but also reflect the service quality at the same time. With the development of China's economy and the improvement of national health awareness, people's requirements for the quality of eye health service are also gradually improving. The focus of China's eye health work has entered the high-quality development stage of ophthalmic medical service system. Therefore, during the "14th five year plan" period, these two indicators will be incorporated into the plan and used as indicators of China's eye health service evaluation system, which will help patients to "see clearly" on the premise of "seeing", so as to realize the high-quality development of China's eye health services.
4、 Focus on strengthening the construction of information platform
The plan emphasizes the construction of eye health service platform. China's large population base, vast territory and rapid population aging process have led to the rapid growth of the demand for ophthalmic services and the relative lack of ophthalmic resources in remote areas. The eye health information platform is of great significance to solve this problem. Compared with traditional diagnosis and treatment, Internet diagnosis and treatment, telemedicine and other information technologies are conducive to the effective downward movement of high-quality ophthalmic medical resources, and can effectively improve the accessibility and affordability of ophthalmic medical services. At the same time, promoting the deep integration of emerging technologies such as big data, artificial intelligence and 5G with ophthalmic services is conducive to consultation, referral and follow-up. It greatly facilitates the diagnosis of common eye diseases, especially chronic diseases related to fundus diseases, such as diabetic retinopathy, macular degeneration, etc. Information construction helps to improve the efficiency of ophthalmic diagnosis and treatment services, the effective integration and rational application of ophthalmic resources, and is conducive to the accurate prevention and treatment of ophthalmic diseases and slow down the process of blindness. The establishment of ophthalmic case database helps to accumulate a large amount of ophthalmic data. On the one hand, it can provide data support for clinical scientific research, on the other hand, it is conducive to the real-time optimization iteration of artificial intelligence model algorithm, provide high-quality data support for eye disease diagnosis model and realize a virtuous circle.
5、 Pay attention to the early prevention of eye diseases
The plan emphasizes "prevention first and combination of prevention and treatment", so as to "move the gateway forward". In addition to continuing to strengthen the construction of grass-roots ophthalmic service capacity, the construction of eye health science popularization platform also plays an important role. Popular science publicity and health education are "social vaccines" for disease prevention and control. They are one of the key means to promote the broad masses of the people not to get sick and get sick less. They are also important measures to realize the healthy China strategy. In the popularization of eye health science, we need to highlight the key concept of "everyone is the first person responsible for their own eye health", and transform the knowledge of loving and protecting eyes into good eye health behavior. In addition, to run through the concept of paying equal attention to both scientificity and popularity of popular science work, we need to rely on the technical advantages of Ophthalmology professionals to transfer correct and scientific knowledge, and also need to transfer eye health knowledge in a simple and easy to understand way, so as to achieve effective science popularization, improve the awareness of loving and protecting eyes, and help prevent eye diseases.
Promoting children's visual health has become the top priority of China's eye health work. 0-6 years old is a key period for children's eye structure and visual function development. The visual development before the age of 6 affects the visual quality of children's life. Therefore, it is very important to achieve early monitoring, early detection, early warning and early intervention. To carry out eye care and vision examination for children aged 0-6 and establish vision files, we need to give full play to the role of grass-roots medical and health institutions, strengthen cooperation with maternal and child health institutions, and build a child eye care service network with clear division of labor, different emphases and close cooperation.
In short, with the continuous promotion of blindness prevention and treatment and eye health in China, the development of eye health in China has gradually changed from disease treatment to people's health. The introduction of the plan will help to improve the prevention and treatment level of key eye diseases and the construction of eye health system, and promote the high-quality development of eye health in China.
Expert interpretation II
Strengthening the construction of ophthalmic medical service system
Promote the high-quality development of eye health work
Eye, ear, nose and Throat Hospital Affiliated to Fudan University
Zhou Xingtao
Entering the new journey of the 14th five year plan, with the continuous change of lifestyle and the accelerating process of population aging, the people's eye health needs show a new trend of multi-level and diversification. In this context, the national eye health plan for the 14th five year plan (2021-2025) (hereinafter referred to as the plan) was officially issued, which marks that China's eye health work has entered a new stage of high-quality development. It has very important guiding significance for the majority of eye health workers to strengthen confidence, build consensus and promote the sustainable development of eye health work.
Focusing on "high-quality development", the plan has made a comprehensive and systematic plan for the construction of medical service system, the prevention and treatment of key eye diseases for key populations and the construction of service support platform. Starting from the four dimensions of ophthalmic medical service system construction, service capacity construction, professional talent team construction and medical quality management, this paper incisively expounds the paths and measures to strengthen the construction of ophthalmic medical service system, which points out the direction for solidly and effectively promoting the high-quality development of eye health work.
1、 Emphasize "making up for weaknesses" and "strengthening advantages", and grasp with both hands
For the overall layout of the ophthalmic medical service system, the plan proposes a five-level ophthalmic medical service system of "country region province city county", emphasizing the expansion and extension of high-quality resources. The plan puts forward important measures to "make up for weaknesses and strengthen the grass-roots level", such as setting up ophthalmology in general hospitals above level II, encouraging qualified county-level hospitals to set up ophthalmology independently and provide outpatient services. The overall improvement of ophthalmic medical service ability also needs to strengthen the leading role of the "national team" in the whole system, so we must pay attention to "strong advantages" while "making up for weaknesses". The plan emphasizes the importance of building a highland of Ophthalmology medicine. We should focus on the construction of national medical center and national regional medical center, and give full play to the leading role of central technology and radiation. In the operation process of the five-level ophthalmic medical service system, each link can not only perform its own duties, but also operate cooperatively, which will help to gradually reduce the difference of ophthalmic medical service capacity between regions and between urban and rural areas, reduce the cross regional flow of patients, and promote and implement hierarchical diagnosis and treatment.
2、 Use information technology to provide comprehensive, fair and accessible eye health services
The fairness and accessibility of medical resources have always been the concern of the people. In order to solve this problem, the plan encourages strong ophthalmic specialized hospitals and general hospitals to take the lead in establishing specialized alliances, integrate resources and improve the overall service capacity. Based on the construction of urban and county eye health work networks, Through the telemedicine cooperation network, the high-quality medical resources of Ophthalmology can be extended to the grass-roots level more efficiently. In order to achieve this goal, we can make full use of the advantages of remote diagnosis and treatment and Internet hospitals, such as efficiency, convenience and personalization, open up online and offline services, form an Internet-based specialist alliance medical service network, effectively promote the scale, normalization and accessibility of eye health medical services, and sink medical resources, Especially during the normalization of epidemic prevention and control, it plays an important role in facilitating people to seek medical treatment nearby. On this basis, we can further deepen the integrated development of digital technology and medical services, integrate 5g, big data, cloud technology, artificial intelligence technology and other new generation information and communication technologies, and deeply apply them in the actual ophthalmic medical service scenarios, so as to make remote eye health services more intelligent, efficient, accurate and safe.
3、 Emphasize the combination of prevention and treatment and provide life-cycle continuous eye health services
With the development of the times, more and more people realize that the development of eye health has changed from treating diseases to people's eye health. The plan has repeatedly mentioned the importance of the combination of prevention and treatment and life-cycle services, established the basic principle of "prevention first and combination of prevention and treatment", encouraged the multi-dimensional combination of medical institutions with disease prevention and control institutions, maternal and child health care institutions and rehabilitation institutions, and built a screening diagnosis treatment follow-up continuous diagnosis and treatment life-cycle service system. Taking myopia prevention and control as an example, at present, the prevention and control of myopia among children and adolescents is included in the government performance appraisal. The plan not only emphasizes relevant contents in many places, but also puts forward clear and specific objectives for relevant indicators. In fact, myopia prevention and treatment is a priority task throughout the whole life cycle. Before the age of 3, refractive development files should be established as soon as possible, and accurate intervention should be carried out in combination with family history. After the establishment of refractive development files, continuous tracking, observation and classified intervention should be carried out at different ages to ensure the accuracy of science popularization, screening standardization and diagnosis and treatment standardization in the whole process. At present, some regions have tried to build Internet-based cloud refractive archives, and actively build a benign "prevention control treatment" system of "school community medical institution family", which effectively ensures the prevention, control and treatment management of myopia in the whole life cycle, which is worthy of further improvement and promotion.
4、 Promote day surgery and appointment diagnosis and treatment, and improve the efficiency of medical services
Day surgery is a rapidly developing surgical medical service mode. Due to its disease diagnosis and treatment characteristics, ophthalmology is more suitable for day surgery and even outpatient surgery on the premise of ensuring medical quality, which is very beneficial to improve service efficiency. The plan clearly proposes to expand the range of diseases of daytime surgery and continuously improve the proportion of daytime surgery in elective surgery. Tertiary ophthalmic specialized hospitals specifically require more than 60%, which will greatly promote the efficiency of ophthalmic medical services. In addition, the plan also emphasizes the construction of a "separation of urgency and slowness" model to promote the information-based appointment system for ophthalmic outpatient and daytime surgery services, which will help to further improve the efficiency of medical services and improve the patient experience.
5、 Pay attention to the construction of talent team and focus on the cultivation of high-level compound talents
"The strength of the country is due to people, and the success of talents comes from learning". The high-quality development of eye health medical service system depends on the construction of high-quality talent team and high-quality talent training system. The plan puts forward the goal of striving to have more than 50000 ophthalmologists and more than 3.6 ophthalmologists per 100000 people at the end of the 14th five year plan. There is a clear quantitative goal for the growth of the base of ophthalmic professional and technical personnel. On the basis of quantitative objectives, the plan specially emphasizes the need to "focus on cultivating high-level compound ophthalmologists" and focus on "high-level leading talents and innovative teams", which is consistent with the overall idea of high-quality development of eye health medical services. The core is to ensure that the ophthalmologist team develops in a stable, reasonable and high-quality direction with the increasing base. In terms of the training system, the plan focuses on the standardized training of residents and continuing medical education, focuses on the training orientation of "taking the clinical diagnosis and treatment ability as the core", guides the transformation of ophthalmic education to the improvement of clinical technical ability, and enables ophthalmologists to carry out diagnosis and treatment work in a more standardized and homogeneous manner.