Table 1. Core actions and strategies to achieve people-centred integrated care in Luohu district, Shenzhen city, China.

Core action areaa	Implementation strategiesa	Implemented?	Specific description in the Luohu model	Document reference
Primary care as first contact	Patient registration	Yes	Residents in Luohu district are encouraged to sign a contract with a general practitioner voluntarily. The agreement defines a package of services, the service delivery process, and the rights and obligations of both patient and provider. Contract period is one year with a specific general practitioner. At the end of the period the patient can sign a contract with another general practitioner, which allows some element of patient choice.	Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district
	Risk stratification	Under preparation	Previous electronic information systems could not support risk stratification. Luohu hospital group is preparing to collect data for a risk stratification exercise based on disease burden, using a new computer application program.	NA
	Gatekeeping	Yes	Patients are strongly encouraged to see their primary health-care provider before a visiting a hospital specialist. However, they are not formally required to do so. To promote patients’ use of family medical practices as the first contact, district-level hospitals assign specialists to work temporarily in community health stations.	Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district
	Ensuring accessibility	Yes	Home visits are provided for patients who sign a contract with a general practitioner, especially for the elderly people.	National Health and Family Planning Commission of Luohu district resolution no. 67 [2015]: Implementation plan for home visits in Luohu district
Multidisciplinary teams	Team composition, roles and leadership	Yes	In community health stations, each primary care team consists of a general practitioner (leader), nurse, public health physician and health promotion practitioner and may also include specialist physicians (e.g. geriatrician, paediatrician, internist), pharmacist, nutritionist or psychologist. The roles of each member are clearly defined, with flexibility to adjust roles based on patients’ needs and the context.		Luohu government resolution no. 5 [2017]: Lessons learnt from the Luohu model to promote the construction of district hospital group in Shenzhen
	Individual care plans for patients	Under preparation	The hospital group is preparing to use care plans for high-risk patients identified by a risk stratification approach.		NA
Vertical integration	Definition of facility roles within a vertically integrated network	Yes	The Luohu model defines the roles of each component of the hospital group to ensure coordination. District-level hospitals are centres of excellence in technology and staff expertise, focusing on providing high complexity of care and valuable rescue care for life-threatening situations. District hospitals also provide technical assistance and training to community health stations. Community health stations focus on providing preventive care, rehabilitation, case management and medical care for common diseases		Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district Luohu hospital group resolution no. 3 [2017]: Charter of the Luohu hospital group (revised version of 2017) Luohu government resolution no.5 [2017]: Lessons learnt from the Luohu model to promote the construction of district hospital group in Shenzhen
	Provider-to-provider relationships	Yes	In the hospital group, provider-to-provider relationships are strengthened through technical assistance and capacity-building. District-level hospitals are responsible to provide clinical technical assistance through training, education and joint consultations to physicians in community health stations. Meanwhile, physicians in community health stations are encouraged to get three months of training in the hospitals
	Forming facility networks	Yes	The hospital group was established in the form of an independent corporation consisting of 23 community health stations, five district hospitals and an institute of precision medicine (which mainly provides diagnostic testing). A council of government officials and representatives from local communities was set up, to which the group are accountable to. Six administrative centres were re-organized using the resources of the respective centres in the former five district-level hospitals. Twelve centres provide resources and management for the whole group
Horizontal integration	Integrating of different types of care	Yes	The multidisciplinary primary health-care teams include former health promotion staff from family planning stations, public health physicians from the Chinese Center for Disease Control and Prevention and specialists from hospitals. Teams work cooperatively with other members to provide preventive care, screening, diagnosis, treatment, rehabilitation and case management for patients. Six resource-sharing centres (human resources, quality management, financial, research and education, community health station management and general management; Fig. 1) allow for more efficient use of resources through reducing care overlap		National Health and Family Planning Commission of Luohu district resolution no. 4 [2016]: Implementation plan for appointing public health physicians to work in community health stations
E-Health	Integrated electronic medical records systems	Yes	The hospital group designed the Healthy Luohu computer application. By logging into their personal account, both providers and patients can access electronic health records systems		Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district
	Communication and care management functions	Yes	The Healthy Luohu application allows patients to request an online appointment with a specific physician in all institutions. Staff in community health stations can make an online referral for patients to hospitals. The application is also easy for patients to check physician information and update registration and payment forms
	Interoperability of e-health across facilities and services	Under preparation	Providers in hospitals and community health stations can view patient records in their own institution. Luohu hospital group is establishing regulations to allow the electronic systems to link across institutions securely and effectively		NA
Integrated clinical pathways and dual referral	Integrated clinical pathways for care integration and decision support	Under preparation	Clinical pathways are being created to standardize the treatment and referral pathways between providers		NA
	Dual referral pathways within integrated care networks	Yes	In the referral gateway model, patients referred from community health stations are expected to receive expedited care in the district-level hospitals. Down-referral, which allows referrals of patients from hospital to community health stations for rehabilitation care or follow-up, is incentivized by a new health insurance payment system in the Luohu hospital group		Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district
Measurement and feedback	Standardized performance measurement indicators	Yes	The Luohu hospital group established a performance measurement system and makes annual self-evaluations. Indicators focus on measures of capacity-building of staff at community health stations (e.g. numbers of staff working in the community health stations, numbers of outpatients) and obtaining patients’ experiences		Luohu government resolution no. 24 [2015]: Implementation plan for comprehensive reform of public hospitals in Luohu district
	Continuous feedback loops to drive quality improvement	Yes	The results are communicated back to stakeholders at all levels, early positive results and challenges are identified. The hospital group is designing new strategies based on measurement results of the last two years
Certification	Certification criteria for local and national use	No	NA		NA
	Targets for criteria and use to certify facilities	No	NA		NA

NA: not applicable.

^a Core action areas and implementation strategies suggested by the policy report Deepening health reform in China.¹⁵