Objective To learn the cognitive appraisal of the necessary conditions for the medical services delivery synergy by doctors at county and township levels,and to provide evidence for the health policy in question.Methods One county-level public hospital and one township hospital were randomly sampled from five sampled counties of Yancheng city in Jiangsu province for a field survey.The questionnaire was designed to cover such dimensions as institutional,information,service,interpersonal and management,in an effort to learn the cognitive appraisal of such doctors on such aspects as the two-way referral between county-township medical institutions,medical information sharing,good personnel relationships of medical workers,service collaboration,and necessity of inter-agency physician teams. Results These doctors in general presented different appraisal for two-way referral between county-township medical institutions,medical information sharing,service collaboration,good inter-personnel relationships and necessity of inter-agency physician teams.Those of lower academic titles considered it necessary to set up inter-agency physician teams(χ2=6.723,P<0.05);while county public hospitals′physicians considered that two-way referral between county-township medical institutions and inter-county agency information sharing as necessary to achieve the synergy of medical services delivery (P<0.05);most township physicians considered that good personnel relationships and service collaboration as necessary to achieve the synergy (P<0.05 ).Conclusions The characteristics of county and township physicians′appraisal of the necessary conditions for synergy of medical services delivery deserve attention,for improvement of their appraisal of two-way referral and information sharing among institutions.

Objective To establish an influencing factors system for the implementation effect of the vertical integration of services between the hospitals and community health service institutions.Methods Primary data related to influencing indicators were collected by literature review,questionnaire method and in-depth interview,and then the analytic hierarchy process (AHP) and Delphi method were used for the construction of final influencing factors indicator system.Results An influencing factors indicator system which coincides with the status of the vertical integration between hospitals and community health service institutions in Nanjing,Wuhan and Zhenjiang was established,including 4 firstlevel indicators,10 second-level indicators and 36 third-level indicators.Conclusion This study can provide a basis for hospitals and community health centers to improve the integration service system,and fill the gap of research on the influencing factors of the vertical integration of the domestic health care system,which are meaningful for the vertical integration of health care system in other districts and patterns.

Objective To investigate the influence of acupuncture and stage health education on the function rehabilitation of stroke patients with depression.Methods 85 patients with poststroke depression were divided into a treatment group (44) and a control group (41).All the cases were treated with routine neurological therapy.Based upon it,the treatment group was given acupuncture and stage health education.Barthel (BI) index and movement scale Fugl Meyer (FMA),depression scale Zung (SDS) and Hamilton Depression Scale (HAMD)were observed in the two groups before and after the treatment.Results After eight weeks treatment,the scores of SDS and HAMD in the two groups were (46.97±12.17),(26.04±5.37),compared with the pretreatment scores(56.07± 5.51),(32.74± 5.17),they were significantly reduced.The scores ofBI,FMB were(67.13 ±15.53),(64.41 ±20.03) which were significantly increased (average P＜0.01),this increase was more significant in the treatment group (P＜0.05) Post-stroke depression comparison:the total effect of SDS and HAMD in the treatment group was (77.88％,78.6％),which was more superior to the control group (56.6％,52.4％).Conclusion The acupuncture and stage health education has a significant clinical treatment effect on the patients suffered from post-stroke depression and also can enhance their body movement function as well as the daily ability.

Objective:To compare the clinical efficacy of the Simultaneous three scopes combined surgery [laparoscopic cholecystectomy(LC)+ choledochoscopy exploration + choledochectomy and removal of the common bile duct + primary suture of the common bile duct + endoscopic guided nasobiliary duct placement] and staged two scopes surgery[endoscopic retrograde cholangiopancreatography (ERCP) combined with LC] in the treatment of choledocholithiasis and cholecystolithiasis.Methods:From January 2018 to June 2020, we retrospectively analyzed the clinical data of 83 patients with choledocholithiasis and choledocholithiasis, who underwent minimally invasive treatment in our center. According to the different surgical procedures, the patients were divided into three-mirror group ( n=42) and two-mirror group ( n=41). All patients in the three-mirror group underwent three-scopy combined surgery. The patients in two-mirror group received endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC). In this study we compared the relevant clinical indicators of the two groups, in terms of the operation time, intraoperative blood loss, one-time stone clearance rate, postoperative exhaust time, postoperative defecation time, total hospitalization cost, incidence of postoperative acute pancreatitis, postoperative stone recurrence rate, incidence of postoperative cholangitis, and incidence of postoperative biliary fistula, total hospitalization time, postoperative bile duct stricture rate. Use SPSS 26.0 software to statistically analyze various indexes such as intraoperative, postoperative, follow-up, etc. Normally distributed measurement data were described by the mean±standard deviation ( Mean± SD), the comparison between groups was by t test, and measurement data with skewed distribution were destribed as M( P25, P75), Pairwise comparisons were analyzed using nonparametric test. The comparison of count data between groups was by the chi-square test. Results:No death was observed in both two groups. The operation time, intraoperative blood loss, one-time stone clearance rate, postoperative exhaust time, and postoperative defecation time of the three-mirror groupwere (167.98±47.37) min, 50(50, 100) mL, 100%(42/42), (2.10±0.76) days, 3(3, 4) days, the two-mirror group were (143.80±34.47) min, 50(50, 50) mL, 85.4%(35/41), (1.53±0.99) days and 2(1, 3) days. Compared with the two groups, the three-mirror group was higher than the two-mirror group, and the difference was statistically significant ( P<0.05). The total hospitalization expenses, postoperative acute pancreatitis incidence, and postoperative calculus recurrence rate in the three-mirror group were (3.46±0.77) ten thousand yuan, 0(0/42), 2.38%(1/42), the two-mirror group were (4.22±1.50) ten thousand yuan, 9.8%(4/41), 19.5%(8/41). Compared with the two groups, the three-mirror group was lower than the two-mirror group, and the difference was statistically significant ( P<0.05). No postoperative cholangitis or biliary fistula occurred in the two groups. There was no statistically significant difference in the total hospital stay and incidence of postoperative bile duct stenosis between the two groups ( P>0.05). Conclusions:For choledocholithiasis combined with cholecystolithiasis patients, simultaneous three-scopes combined surgery and elective LC after ERCP are safe and effective, and each has its own advantages. It should be selected reasonably according to the patient′s condition and combined with the technical advantages of the treatment team.

During the process of China’s healthcare reform, the concept of “costly access to health care” has been discussed for quite a long time. However, big data indicates that a small number of patients (5%) account for disproportionate costs ( approximately 50%) . “Costly access to health care” may not be a ubiquitous perceived prob-lem for all residents. In this paper, the concept“high-need patient” will be introduced and the characteristics of the population will be analyzed. According to the healthcare reform experience from the international perspective, this paper proposed healthcare strategy for Chinese high-need patients and policy recommendations for China’s healthcare reform.

Objective:To survey the status general practice residency training and career choice of trainees in Henan Province.Methods:From December 2017 to February 2018, 332 trainees from the first general practice residency training program (2014-2017) were enrolled in the study. The self- administered questionnaire included the demographic information and the current career status. The logistic regression model was used to analyze the influencing factors of the career choice when their completed the training.Results:Of 332 participants, there were 167 participants designated by the institutions and the others were directly enrolled by the program. The designated participants were from the 56 medical institutions in Henan. The percentage of participants from the tertiary hospitals was 75.5% (126/167), which was much higher than that from the secondary hospitals (24.5%,41/167). There were 24 participants who did not have a work six months after graduation. Of the 308 employed participants, there were only 111 (36.0%, 111/308) working in the department of general practice, and 197 (64.0%, 197/308) working in other departments. The participants designated by the institutions and with the post-graduate degrees preferred to choose other specialties, instead of the general practice. The reasons were that there was no department of general practice in their institutions or the participants had been designated to the other departments (57.9%, 114/197).Conclusion:The survey suggests that the general practice residency training program should enroll trainees mainly from the medical graduates in order to improve the effectiveness of general practitioner residency training and the allocation of health resources in Henan Province.

Carrying out the optimal location selection of medical equipment in the medical community plays an important role in scientifically allocating equipment resources and improving the service capacity of medical community. Aiming at minimizing the operating cost of the location selection and configuration of the portable color Doppler ultrasound instrument in the county medical community and the shortest time spent on medical visits for residents, the authors established the total value objective function of the medical community configuration according to the value engineering method; and considered the relevant constraints such as distance, time and personnel quality, the mathematical model of optimal planning for the selection and configuration of portable color Doppler ultrasound equipment in county medical community was constructed. The empirical research results showed that based on the established constraints, after 5 000 iterations, the model output 5 relatively optimized allocation points among the 9 allocation points, and when the allocation number of each allocation point was 1, the total allocation value in the medical community reached the maximum. This study could provide a new idea and feasible method for the allocation of equipment resources of county medical community in China.

Objective To construct a systematic evaluation model of the operation and management capacity of pub-lic hospitals,and to objectively and realistically assess the current status of the operation and management capacity of public hospitals.Methods The"input-process-output"framework was used to construct a systematic evaluation model for operation management capability.56 public hospitals at or above the secondary level were sampled to con-duct empirical research.Results The results showed that,operation management in current stage emphasized a"re-sult oriented"approach,with insufficient basic investment and unclear core activities.Increasing funding investment,strengthening hospital marketing,and improving output quality were the core tasks of operation management.The operation management were generally in the initial stage,and the overall ability was not strong.The ability advantages of tertiary hospitals were relatively prominent.Conclusion It recommended that public hospitals should focus on the five major elements of human resources,finance,information,systems and decision-making mechanisms to com-prehensively optimize operation management investment;precise core activities,and promote the modernization of the economic system by improving the efficiency of resource allocation;stimulate the potential of hospitals,medi-cal staff,and disciplines to improve the quality of comprehensive outputs.

Objective To explore the effect of troponin Ⅰ (anti-cTnⅠ) autoantibodies on the quality of life and prognosis in patients with ischemic cardiomyopathy.Methods Patients hospitalized in Henan Provincial People's Hospital for ischemic cardiomyopathy from June 2016 to June 2017 were enrolled.At the same time,physical examiners were selected as the control group.Anti-cTnⅠ autoantibodies were detected in the serum from the patients and control group,which were expressed as the OD value.After six months,all patients were followed up,including death,times of readmission,instrument treatment (CRT-P or CRT-D) or heart transplantation,and quality of life questionnaire (SF-36).The effect of anti-cTnⅠ autoantibodies on the prognosis and quality of life were analyzed.Results In 127 patients with ischemic cardiomyopathy,the OD value of anti-cTnI autoantibodies were significantly higher than that in the control group[(0.55 ± 0.24) vs (0.46 ± 0.07),P＜0.05].With a positive standard of more than 0.67,26 patients with ischemic cardiomyopathy were tested positive for anti-cTnⅠ autoantibodies,with a positive rate of 20.5％.After 6 months of outpatient or telephone follow-up,9 patients were lost to follow-up,and 118 patients were followed up,including 24 patients with positive anti-cTnⅠ autoantibodies.Compared with patients with negative anti-cTnⅠ autoantibodies,the times of readmission in patients with positive anti-cTnⅠ autoantibodies increased significantly[(1.42 ± 0.79)vs (0.30 ± 0.55),P＜0.01] and the physiological function was decreased significantly[(56 ± 19.4) vs (67 ± 20.8),P=0.032].The physiological function,vitality and social function of patients with reduced ejection fraction in the anti-cTnⅠ autoantibodies positive group were significantly worse than those in the anti-cTnI autoantibodies negative group,but there was no significant difference in quality of life between the anti-cTnⅠ autoantibodies positive and negative groups in the patients with preserved and median ejection fraction.Conclusions Patients with ischemic cardiomyopathy of seropositivity for anti-cTnⅠ autoantibodies have worse prognosis and quality of life,especially in those with reduced ejection fraction.

Based on the reality that the Health Management Alliance(HMA)has been initially established nationwide as an important component of the integrated health care service system,on the basis of summarizing the evolution process of transaction cost theory,discriminating the essential characteristics of HMA,deconstructing HMA transaction cost and putting forward a quantitative measurement model,the coping strategies of HMA transaction cost are summarized into three levels:"knowing","reducing"and"increasing".It aims to solve the high transaction cost effectively and explore the economic system supply path;correct the deviation of the field of vision which only focuses on the"output orientation"of HMA in the early stage,and arouse the attention and thinking of all parties on the transaction cost of HMA;provide a new position and a new idea for HMA policy research and reform practice in China.