Implementation of the clinical pathway is key to the ongoing health reform in China. However,the hospital is faced with such hurdles as low incentive among the medical workers,low utilization rate,high pathway-deviation rate among others.Therefore,this paper combined management practices of a tertiary military hospital,analyzed factors influencing its application,and discovered the key factors for the pathway system.Then the corresponding countermeasures were formulated and implemented with significant effects.

A description of the positioning of public hospitals in China, and an exploration of such issues as their compensation mechanism, management system, and operation mechanism. The authors hold that it is imperative to maintain a reasonable balance of the government, society and individuals in their share of healthcare expenditure, prioritize funding recipients, and encourage medical cost payment based on disease diagnosis groupings; to precisely distinguish the ownership, operation right, decision right, and supervision right of public hospitals, for building an effective incentive and supervision mechanism; to further consolidate the president responsibility system and target responsibility system, build a flexible talent use system and distribution mechanism, build a better quality control mechanism, a strict expenditure and cost control mechanism, and a scientific talent development mechanism as well.

Widely accepted in other countries,DRG payment is also referred to in China now and then.The authors reviewed the status quo of medical payment in China,as well as the practices and studies of DRG payment overseas.Based on such studies,the paper probed into the feasibility of DRG application in China,in terms of policy environment,application demand,research basis and technical conditions.Proposed in the paper are ranges of application,possible roadblocks and countermeasures for the application in China,aiming to promote the research,application and use of the method in China.

13th Five-Year period is China's comprehensive completion of the decisive stage of a well-off society,when the development of public hospitals is facing great opportunities and challenges.Five development concepts introduced by the fifth Plenary Session of the 18th CPC Central Committee,offer guidance on public hospital reform and development.Among such concepts,innovation is leading the first power of hospital development;Coordination is the inherent requirements of the hospital' s sustainable and healthy development;Green is a necessary condition for the sustainable development of the hospital,and also an important reflection of the hospital development achievement;Opening is the only way for the rapid development of hospital;Sharing is the essential requirement of hospital development.Five development concepts shall guide the reform and development of Chinese public hospitals during the period of 13th Five-Year.

Thanks to the three decades of reform and opening up,hospitals in China have made tremendous achievements in their development,yet facing new ehallenges as well.to address these challenges,there is an urgent need for these hospitals to further their reform under the guideline of the scientific concept of development.This will help them strengthen their hospital culture,quality control,technology,human resources development,and their leadership,in order to achieve a better and faster growth,better serving the role to build a harmonious socialist society.

Objective To seek a rational method of estimating the demands for medical services so as to work out regional health planning in a scientific way. Methods A metropolis including 19 counties and districts was selected as a region and demands for medical services were forecasted via retrospective analysis and the econometric model. Results A model of the demands for outpatient and inpatient services was obtained based on the impact of many social and economic factors on medical health services, and illustrations were given to indicate the demands for medical health services in the 19 counties and districts in future when prices should rise by 15% and 20%. Conclusion The econometric model can be used as a tool for estimating the demands for medical health services, and yet improvements need to be made.

OBJECTIVE:To establish a method for simultaneous determination of tanshinol,caffeic acid,rosmarinic,salviano-lic acid B,salvianolic acid A,tanshinoneⅠ,cryptotanshinone,tanshinone ⅡA and ursolic acid in Compound xueshuantong cap-sules. METHODS:UPLC-MS/MS method was adopted. The determination was performed on ACQUITY UPLC? BEH C18 column with mobile phase consisted of acetonitrile-0.1%formic acid(gradient elution)at the flow rate of 0.2 mL/min. The column tempera-ture was 40 ℃,and the temperature of injector was 10 ℃. Analysis time was 7 min,and sample size was 5 μL. The electrospray ionization source(ESI)was used;ion source temperature was 150℃;capillary voltage was 3.5 kV;cone flow was 50 L/h;desol-vation temperature was 350 ℃;desolvation gas flow was 650 L/h;nebuliser pressure was 7 × 105 Pa;ion monitoring and multiple reaction monitoring (MRM) was performed. RESULTS:The linear ranges of tanshinol,caffeic acid,rosmarinic,salvianolic acid B,salvianolic acid A,tanshinoneⅠ,cryptotanshinone,tanshinone ⅡA and ursolic acid were 10.0-100.0 μg/mL (r=0.9998), 0.1-1.0 μg/mL(r=0.9998),4.0-40.0 μg/mL(r=0.9999),10.0-100.0 μg/mL(r=0.9999),15.0-150.0 μg/mL(r=0.9997), 8.0-80.0 μg/mL(r=0.9998),10.0-100.0 μg/mL(r=0.9997),50.0-500.0 μg/mL(r=0.9997)and 6.0-60.0 μg/mL(r=0.9998), respectively. The limits of quantitation were 40.0,9.6,38.0,88.0,130.0,39.0,4.4,3.2 and 10.0 ng/mL,separately. The limits of detection were 12.0,3.0,11.0,26.0,39.0,12.0,1.3,1.0 and 3.0 ng/mL,respectively. RSDs of precision,stability and repro-ducibility tests were all lower than 3%. The recoveries were 97.34%-103.20%(RSD=2.19%,n=6),97.22%-102.39%(RSD=2.03%,n=6),98.51%-101.70%(RSD=1.32%,n=6),97.86%-102.49%(RSD=2.09%,n=6),96.75%-103.12%(RSD=2.36%,n=6),98.43%-101.65%(RSD=1.25%,n=6), 97.59%-101.50%(RSD=1.50%,n=6), 96.45%-102.88%(RSD=2.58%,n=6),97.02%-103.11%(RSD=2.38%,n=6),separately. CONCLUSIONS:The method is simple and accurate,and can be used for simultaneous determination of 9 components in Compound xueshuantong capsules.

Background/Aims: Achalasia is a rare disease, but the incidence is increasing recently. Peroral esophageal myotomy (POEM) is an effective treatment.Regurgitation is a common symptom before and after POEM. Our aim is to investigate the factors related to preoperative and postoperative reflux symptoms. Methods: Our study was retrospective. The achalasia patients diagnosed by high-resolution manometry and gastroscopy were divided into reflux group and non-reflux group before and after POEM, respectively. General information, symptoms, POEM information, and manometric results were compared. Results: (1) Ninety-six of 130 patients had reflux symptoms before POEM. The lower esophageal sphincter pressure (LESP) in the reflux group was significantly higher than the non-reflux group (P = 0.023), while integrated relaxation pressure (IRP) was similar. The reflux group had longer esophagus than the non-reflux group (P = 0.006). Reflux symptoms were not related to subtypes of achalasia.(2) Twenty-five of 84 patients had reflux symptoms after POEM. Postoperative Eckardt scores, LESP, and 4-second IRP (4sIRP) were significantly lower than the preoperative values (P < 0.001). The preoperative values and POEM information were similar between the postoperative 2 groups and there was no significant difference in the presence of preoperative reflux symptoms between 2 groups.The postoperative LESP and 4sIRP were similar between the 2 groups, however, the postoperative UESP was significantly higher in the reflux group than the non-reflux group (P = 0.042). The non-reflux group had more declines in Eckardt scores and LESP than the reflux group. Conclusions The reflux symptoms of achalasia patients without treatment were mainly due to food retention. The postoperative reflux symptoms were not the sign of the excessive relaxation of lower esophageal sphincter.

Background/Aims: Achalasia is a rare disease, but the incidence is increasing recently. Peroral esophageal myotomy (POEM) is an effective treatment.Regurgitation is a common symptom before and after POEM. Our aim is to investigate the factors related to preoperative and postoperative reflux symptoms. Methods: Our study was retrospective. The achalasia patients diagnosed by high-resolution manometry and gastroscopy were divided into reflux group and non-reflux group before and after POEM, respectively. General information, symptoms, POEM information, and manometric results were compared. Results: (1) Ninety-six of 130 patients had reflux symptoms before POEM. The lower esophageal sphincter pressure (LESP) in the reflux group was significantly higher than the non-reflux group (P = 0.023), while integrated relaxation pressure (IRP) was similar. The reflux group had longer esophagus than the non-reflux group (P = 0.006). Reflux symptoms were not related to subtypes of achalasia.(2) Twenty-five of 84 patients had reflux symptoms after POEM. Postoperative Eckardt scores, LESP, and 4-second IRP (4sIRP) were significantly lower than the preoperative values (P < 0.001). The preoperative values and POEM information were similar between the postoperative 2 groups and there was no significant difference in the presence of preoperative reflux symptoms between 2 groups.The postoperative LESP and 4sIRP were similar between the 2 groups, however, the postoperative UESP was significantly higher in the reflux group than the non-reflux group (P = 0.042). The non-reflux group had more declines in Eckardt scores and LESP than the reflux group. Conclusions The reflux symptoms of achalasia patients without treatment were mainly due to food retention. The postoperative reflux symptoms were not the sign of the excessive relaxation of lower esophageal sphincter.

Objective:To construct an evaluation index system of perceived service quality for Internet hospitals, and to provide references for scientific evaluation and effective management of such hospitals′ service quality.Methods:Thanks to literature review and expert interviews, an index system was initially built based on the Brady and Cronin model.From August to November 2021, Delphi expert consultation method was used in three rounds of correspondence questionnaire survey, and experts were consulted to assess the importance, familiarity and judgment basis of these indexes. The importance of the indexes was expressed by ± s, and the weight value of each index was calculated using analytic hierarchy process fuzzy comprehensive evaluation method and SPSS Au software. Results:The evaluation index system of perceived service quality for such hospitals included 3 level-1 indexes, namely environmental quality, interaction quality and result quality; and 10 level-2 indexes, namely software platform, service support, social factors, attitude, behavior, professional quality, service effect, service efficiency, service cost, satisfaction; and 30 level-3 indexes. Among these indexes, result quality of level-1 indexes scored the highest weight value(0.337); Software platform, professional quality, service support and attitude of level-2 indexes scored a higher weight values, respectively 0.119, 0.119, 0.109 and 0.109. Of level-3 indexes, reputation of Internet hospitals, service attitude of their doctors and doctor-patient communication skills of doctors online scored a higher weight values, respectively 0.102, 0.057 and 0.055.Conclusions:The index system for Internet hospital perceived service quality evaluation built in this study proved scientific, contributing positively to guiding Internet hospitals to improve their quality and safety management.