Objective To analyze the coordination and continuity of service delivery for hypertension patients in rural health network,so as to provide references for improving integrated service utilization.Methods Self-developed questionnaire of service coordination and continuity delivery according to the research literature at home and abroad was used as the tool,and the data was analyzed by descriptive statistics.Results 49.6％ patients were accompanied by one or more diseases.About 73.0％ had seeking care experience in township health centers.Patients with seeking care to two or more medical institutions accounted for 51.3％.Recommending referral institutions for patients with poor therapeutic effect by grassroots doctors were the biggest proportion with 28.4％ and 68.7％ respectively.The proportion that superior doctors treating patients according to the related information from subordinate institutions was less than 43.0％,the proportion that junior doctors continuing to treat referral patients according to early diagnosis and treatment information was just over 40％.Easier upward referral but harder downward referral also existed among medical settings of different levels.Conclusion The disease characteristics of rural patients increased the possibility of seeking care among vertical medical institutions,but the level of continuity and coordination service delivery was not high in this network.So all-sided service integration to rural tertiary health institutions should be strengthened.

Objective:To explore and test a blending prospective payment that suitable for integrated care delivery system in China.Methods:Referring to Accountable Care Organization and domestic reforms,it designed a performance-based and prospective global budget payment mechanism which mainly contained strategies as medical alliance contract,prepay by DRGs and performance-based management.Through a quasi-experiment,it tested its effects on controlling the inpatient spending and continuity of care.Results:There were 38 980 cases included from inpatient claims data out of 4 towns.194 medical records came from township and county hospitals.Compared to control group,the average hospitalization rate per capita every 5 months in treated group significantly declined by 0.08％,the likelihood of using upper level hospitalization significantly declined by 0.16％,and the continuity of care significantly increased by 33.80％.Global budget system would benefit decreasing hospitalization structure and improving medical collaboration.However,the effects of new model might be underestimated by the imperfect implementation of compulsory referral system.Conclusion:The medical alliances should center on combined objectives as stimulating medical cooperation and improving on quality of care.It should make the blending prospective payment decisions on basis of information-shared grading and referral medical system and empirical evidence.

Objectives:To test the effect of continuous care on rural hypertension control , we developed a com-prehensive intervention strategy and implemented a community-based quasi-experiment in Southwestern rural China.Methods:The intervention took place in Qianjiang District , Chongqing Municipality from July 2012 to June 2014.4 towns were randomly selected and categorized into 2 groups based on a comprehensive consideration of population and social development level.All the rural hypertension patients in treatment group were intervened with the Multi-institu-tional Continuous Pathway which was consisted of three parts:the Continuous Primary-Care Pathway , the Continuous Clinical Pathway and the Continuous Management Pathway.The patients in the control group served as a blank com-parison using the usual care.Difference-in-differences Model was used to test the effect of blood pressure control in treatment group.Results:853 patients were sampled and investigated using the stratified randomly sampling strategy and 712 of them had been followed up by the end of this program.The potential bias of pilot and patient selection were eliminated through control before and after the intervention.The previous blood pressure trends showed no statis-tically significant difference between groups.The systolic blood pressure in treatment group declined by 10.156 mm-Hg ( P<0.001 ) compared to control group after intervention , and the blood pressure control rate had increased by 27.6% ( P<0.001 ).Other contributing factors besides intervention were family structure , education level and med-ical service availability.Conclusion:The continuous care pathway have a significant marginal positive effect on hyper -tension control besides the national compulsory primary care , and the control rate change of blood pressure is more sen-sitive compared to blood pressure change.The potential contributing factors show that other intervention strategies could be developed to improve the rural hypertension control by adding to the social capital of rural patient , reinforcing the health education and facilitating the village transportation.

The aging of population and the increasingly morbidity rate of chronic disease had brought great influence on public health and economy.And community whose scientific management model could improve effectivity was a main prevention place for chronic disease.Thus on the basis of domestic and foreign literatures,several types of chronic disease community management models were introduced,and aimed at providing a reference for community chronic disease management.

The intracellular trafficking and subcellular distribution of exogenous gene is very important for gene delivery. A successful gene vehicle should overcome various barriers including endosomal membrane barriers to delivery gene to the target organelle. Traditional nonviral vehicle is unable to avoid endosomal pathway efficiently, so the efficiency of gene delivery is low and the application of gene drugs is limited. In order to achieve efficient nonviral gene delivery, a lot of researches based on endosomal escape have been carried out and some agents with the function of endsomal escape have been found. These agents facilitate the endsomal escape via various mechanisms, such as fusion into the lipid bilayer of endosomes, pore formation in the endosomal membrane, proton sponge effect and photochemical methods to rupture the endosomal membrane. In this review, various reported strategies for endsomal escape are described according to the escape mechanisms, and their applications in intracellular gene delivery are also discussed.

Taking the reform of DRG payment methods as the background,it discusses how the medical in-surance department uses information technology to achieve refined monitoring and management of medical institu-tions,so as to improve the quality and efficiency of medical services and control the unreasonable growth of medical expenses.The three stages of"precision monitoring-refined supervision-precision governance"of medical insurance DRG based on"refined theory"are proposed;taking Nanjing's"medical insurance high-speed railway"as an example,a DRG refined supervision and governance model framework is constructed,and its analysis is carried out monitoring elements and governance elements,and finally put forward implementation suggestions,including hori-zontal collaboration led by medical insurance,establishing a service and cost evaluation mechanism that combines in-ternal and external services.

Digital transformation is driving the repositioning of government work and the reshaping of public ser-vice models.It uses TOE theory combined with a technology analysis framework as a theoretical perspective and a single-case study approach to explore the operational mechanism and optimization path of health insurance gover-nance modernization.The findings show that the digital transformation of health insurance is in line with the three-stage path of"structuring the enabling mechanism-forming digital service capacity-enabling value creation".The next stage is to promote the implementation of digital coding standards,accelerate the application of technology integration,respond to the needs of the insured,improve the supporting measures for the linkage of the three health care systems,and bring into play the effectiveness of modern governance of health care.It expands the scope of government governance modernisation research and has both theoretical and practical value.

OBJECTIVE：To provide evidence-ba sed evidence for clinical treatment and decision by evaluating efficacy ，safety and cost-effectiveness of denosumab in the treatment of giant cell tumor of bone （GCTB）. METHODS ：Retrieved from PubMed ， the Cochrane Library ，ScienceDirect，CNKI，Wanfang database and VIP as well as health technology assessment （HTA）organi- zation websites ，HTA reports ，randomized controlled trials （RCTs），single-arm trials and retrospective studies were included about denosumab in the treatment of GCTB in the adults and adolescents with mature bone ，and their qualities were evaluated. HTA reports were analyzed with descriptive analysis qualitatively ；Meta-analysis was conducted for single-arm clinical studies and retrospective studies by using R version 3.6.0 software. RESULTS ：Among 49 screened literatures ，there were 6 HTA reports ，5 single-arm trials and 3 retrospective studies ．No eligible RCTs were retrieved. HTA reports of various countries generally believed that denosumab possessed good efficacy and safety ；HTA reports of France ，Austrila and other contries showed that denosumab possessed economics. For the GCTB patients who was unresectable ，denosumab would bring the clinical benefits to about 81％ [95％CI（77％，86％）] of patients. The complete response rate and partial response rate was around 14％[95％CI（10％，19％）] and 51％[95％CI（32％，70％）]，respectively. For the GCTB patients was resectable ，denosumab would prevent some patients from receiving surgery （35％）[95％CI（21％，49％）] or bring surgical down staging to them （40％）[95％CI（36％，45％）]，the postoperative recurrence rate after experiencing the denosumab therapy was about 19％[95％CI（7％，35％）]，and median relapse time was approximately 6.73 months [ 95％CI（3.92，9.55）] after receiving surgery. Main grade 3-4 or high frequercy ADR requiring treatment was back pain ，limbs pain ，hypophosphatemia and jaw osteonecrosis. CONCLUSIONS ：Based on the currently available evidence，among the studies and regions covered in this study ，denosumab has favorable efficacy ，safety and cost-effectiveness in the treatment of TCTB.

Objective It aims to construct an evaluation index system for the development level of intelligent health insurance,which can serve as a reference for health insurance management departments in assessing the develop-ment level of intelligent health insurance and the implementation of health insurance informatization.Methods Key events in intelligent health insurance were identified based on event system theory and text analysis.The evaluation index system was determined through a combination of expert interviews and Delphi expert consultations.The entro-py method was used to calculate the weights of each index,followed by the assessment of the current and ideal de-velopment levels.Results A total of 16 experts were consulted.After two rounds of Delphi expert consultation,two first-level indicators and 18 second-level indicators were finally included in the system.The current development level of intelligent health insurance in China is at the intelligent development stage(2.524 points),while the ideal de-velopment level is at the intelligent improvement stage(4.073 points).The positivity coefficient of both rounds of Del-phi expert consultation was 100%,with an authority coefficient of 0.842,and the degree of expert coordination im-proved with each round.Conclusion The constructed evaluation index system exhibits high scientificity,stability,and generalizability.It can provide an effective evaluation tool for the development of intelligent health insurance in various pooled areas.

It dified framework of health system resilience analysis.The research integrates practical elements from the case of the online pandemic material procurement and allocation hall in Nanjing,categorizing the resilience-building of local health systems via informatization into two distinct dimensions:static foundation and dynamic endowment.It conducts an in-depth examination of the logical pathways that leverage informatization to bolster resilience,and further investigates the inherent advantages and potential areas for optimization within informatization.The findings suggest that the synergistic empowerment of both static foundation and dynamic endowment effectively amplifies the risk defense capability and resilience of local health systems.