Objective:To analyze the grassroots diseases category policy of DIP,explore the influencing mechanism on patient flow,and provide references for other DIP reform pilot regions.Methods:It conducts game theory analysis on the service supply behaviors of different medical institutions under the grassroots diseases category policy,and reveals the reasons affecting the role of grassroots diseases category.Results:Research has found that grassroots diseases can weaken the siphonage of tertiary institutions,but the prerequisite is to establish reasonable disease payment standards;there is a competitive relationship among secondary medical institutions,and secondary medical institutions will still exacerbate grassroots siphonage;the supervision and assessment mechanism for grassroots diseases is not sound,making it difficult to avoid the unreasonable medical service behavior of medical institutions under grassroots diseases.Conclusion:It is needed to further optimize the formulation of payment standards for grassroots diseases in medical insurance departments,consider adding grassroots diseases to primary medical institutions and resolving competitive conflicts between primary and secondary medical institutions,improve the supervision and assessment mechanism for grassroots diseases to prevent unreasonable medical service behavior.

Objective:To compare the results of plasma samples and histological/cytological samples for detection of lung cancer driver gene by next-generation sequencing (NGS), to provide reference for sampling selection of clinical patients.Methods:A retrospective analysis was performed on 220 patients with lung cancer who were admitted to Quanzhou First Hospital in Fujian Province from May 2017 to May 2024, and NGS detection of lung cancer driver gene was performed on both plasma samples and histological/cytological samples. Histological specimens included biopsy or surgical resection of lung cancer, cervical lymph nodes and pleural metastases; the cytological specimen was pleural fluid cell wax block. Specimens were divided into plasma group (experimental group) and matched histological and cytological group (control group). Eight gene variants recommended by the guidelines were EGFR mutation, ALK rearrangement, ROS1 rearrangement, BRAF V600 mutation, RET rearrangement, MET exon 14 jump mutation, KRAS mutation, and NTRK1/2/3 rearrangement. The detection results of the two groups of specimens were compared and analyzed.Results:Among the 220 cases, 183 were adenocarcinoma, 23 were squamous cell carcinoma and 14 were non-small cell lung cancer. There were 4 cases in stage Ⅰ, 3 cases in stage Ⅱ, 24 cases in stage Ⅲ, and 189 cases in stage Ⅳ. In the plasma group, 120 cases were positive, the detection rate was 54.5%; There were 152 positive cases in the control group, the detection rate was 69.1%; the detection rate in the plasma group was lower than that in the control group ( χ2=6.12, P<0.05). The detection rate of plasma in patients with stage Ⅰ/Ⅱ/Ⅲ was 12.9% (4/31), which was significantly lower than that in stage Ⅳ (61.4%; χ2=22.10, P<0.05). In the early clinical stage (stage Ⅰ/Ⅱ) of 7 cases, 3 cases were positive in the control group, while all were negative in the plasma group. There were 24 stage Ⅲ cases, 8 were positive in the control group and 4 were positive in the plasma group. Among the positive cases in the control group, 34 were negative and 4 were not detected in the matched plasma group. In the plasma positive cases, there were 2 negative cases and 4 partial mutations were not detected in the matched control group. Among these 6 cases, 5 were treated patients, and the mean mutation abundance of corresponding plasma positive genes was 1.5%. There were 110 cases with the same positive result (the same mutation site) and 66 cases with the same negative result, with agreement rate of 80.0% (176/220). The sensitivity and specificity of the plasma group were 75.0% (114/152) and 91.7% (110/120), respectively. Conclusions:When NGS is used for lung cancer driver gene detection, the positive rate of plasma samples is lower than that of tissue/cytology samples, but the consistency rate with the latter can reach 80%, and the sensitivity is higher than 70%, which has a good clinical detection efficiency, especially for patients with non-small cell lung cancer stage Ⅳ.

Objective:To analyze the grassroots diseases category policy of DIP,explore the influencing mechanism on patient flow,and provide references for other DIP reform pilot regions.Methods:It conducts game theory analysis on the service supply behaviors of different medical institutions under the grassroots diseases category policy,and reveals the reasons affecting the role of grassroots diseases category.Results:Research has found that grassroots diseases can weaken the siphonage of tertiary institutions,but the prerequisite is to establish reasonable disease payment standards;there is a competitive relationship among secondary medical institutions,and secondary medical institutions will still exacerbate grassroots siphonage;the supervision and assessment mechanism for grassroots diseases is not sound,making it difficult to avoid the unreasonable medical service behavior of medical institutions under grassroots diseases.Conclusion:It is needed to further optimize the formulation of payment standards for grassroots diseases in medical insurance departments,consider adding grassroots diseases to primary medical institutions and resolving competitive conflicts between primary and secondary medical institutions,improve the supervision and assessment mechanism for grassroots diseases to prevent unreasonable medical service behavior.

Objective:To compare the results of plasma samples and histological/cytological samples for detection of lung cancer driver gene by next-generation sequencing (NGS), to provide reference for sampling selection of clinical patients.Methods:A retrospective analysis was performed on 220 patients with lung cancer who were admitted to Quanzhou First Hospital in Fujian Province from May 2017 to May 2024, and NGS detection of lung cancer driver gene was performed on both plasma samples and histological/cytological samples. Histological specimens included biopsy or surgical resection of lung cancer, cervical lymph nodes and pleural metastases; the cytological specimen was pleural fluid cell wax block. Specimens were divided into plasma group (experimental group) and matched histological and cytological group (control group). Eight gene variants recommended by the guidelines were EGFR mutation, ALK rearrangement, ROS1 rearrangement, BRAF V600 mutation, RET rearrangement, MET exon 14 jump mutation, KRAS mutation, and NTRK1/2/3 rearrangement. The detection results of the two groups of specimens were compared and analyzed.Results:Among the 220 cases, 183 were adenocarcinoma, 23 were squamous cell carcinoma and 14 were non-small cell lung cancer. There were 4 cases in stage Ⅰ, 3 cases in stage Ⅱ, 24 cases in stage Ⅲ, and 189 cases in stage Ⅳ. In the plasma group, 120 cases were positive, the detection rate was 54.5%; There were 152 positive cases in the control group, the detection rate was 69.1%; the detection rate in the plasma group was lower than that in the control group ( χ2=6.12, P<0.05). The detection rate of plasma in patients with stage Ⅰ/Ⅱ/Ⅲ was 12.9% (4/31), which was significantly lower than that in stage Ⅳ (61.4%; χ2=22.10, P<0.05). In the early clinical stage (stage Ⅰ/Ⅱ) of 7 cases, 3 cases were positive in the control group, while all were negative in the plasma group. There were 24 stage Ⅲ cases, 8 were positive in the control group and 4 were positive in the plasma group. Among the positive cases in the control group, 34 were negative and 4 were not detected in the matched plasma group. In the plasma positive cases, there were 2 negative cases and 4 partial mutations were not detected in the matched control group. Among these 6 cases, 5 were treated patients, and the mean mutation abundance of corresponding plasma positive genes was 1.5%. There were 110 cases with the same positive result (the same mutation site) and 66 cases with the same negative result, with agreement rate of 80.0% (176/220). The sensitivity and specificity of the plasma group were 75.0% (114/152) and 91.7% (110/120), respectively. Conclusions:When NGS is used for lung cancer driver gene detection, the positive rate of plasma samples is lower than that of tissue/cytology samples, but the consistency rate with the latter can reach 80%, and the sensitivity is higher than 70%, which has a good clinical detection efficiency, especially for patients with non-small cell lung cancer stage Ⅳ.

Objective:To analyze the impact of global budget on the medical flow treatment and fund allocation in a non-compact medical community based on the symbiosis theory, so as to provide references for relevant authorities to formulate policies for the medical community.Methods:Data on outpatient and emergency visits, discharges, and medical insurance fund usage of the leading hospital and primary medical and health institutions in a non-compact medical community were collected from the health information system of a certain city. The time range of the data spanned from January 2017 to December 2019. The total budget was implemented in April 2018. The symbiotic system of the non-compact medical community was analyzed based on the theory of symbiosis. Descriptive analysis and intermittent time series segmented regression model were used to analyze the changes in indexes related to the flow of medical treatment and fund allocation between the leading hospital and primary institutions under the global budget.Results:The non-compact medical community′s symbiotic system had developed a continuous symbiotic model in organization and an asymmetric reciprocal symbiotic model in behavior. From the perspective of medical treatment flow, the number of outpatient and emergency visits of leading hospital and primary institutions in the medical community showed an upward trend, with little change in the number of discharged patients from 2017 to 2019; The number of patients transferred by the leading hospital increased from 32 in 2017 to 87 in 2019. According to the analysis of the intermittent time series segmented regression model, after the implementation of global budget, the proportion of outpatient and emergency visits in leading hospital was decreased ( β3=-0.43, P<0.05), the proportion of outpatient and emergency visits in primary institutions was on the rise ( β3= 0.02, P<0.05). In terms of fund allocation, the share of health insurance fund of the leading hospital increased from 45.98% in 2017 to 46.51% in 2019, and the primary medical and health institutions decreased from 23.44% to 18.06%, as well as the ratio of per capita income of primary medical and health institutions to that of leading hospitals was decreased from 72.62% to 60.79%. Conclusions:Under the global budget, the outpatient and emergency medical treatment flow in a non-compact medical community had been optimized. However, there was an uneven distribution of funds among medical institutions at all levels. Thus it was recommended to continue to give full play to the positive incentive effect of the global budget, establish a scientific mechanism for distributing benefits, and strengthen supervision and management.

Objective:To understand the incentive effect and influencing factors of the current economic incentive policy for medical alliances in Longhua District of Shenzhen(the alliance for short) on doctors′ willingness to work at primary medical institutions(the primary for short) from the perspective of mental account, and to explore the economic incentive effect of different economic incentive distribution methods on doctors′ willingness to work at the primary.Methods:The questionnaire was designed based on mental account theory. Random sampling was made in November 2019 for a questionnaire survey among doctors in two district-level medical institutions of the alliance in Longhua District of Shenzhen. The purpose was to analyze their inclination to work at the primary and their selection preferences for economic incentive distribution methods under the current economic incentive policy. The data were analyzed by descriptive analysis, and the influencing factors of doctors′ willingness to work at the primary were analyzed by χ2 test and binary logistic regression. Results:A total of 254 valid questionnaires were collected with an effective recovery rate of 90.7%. Among the respondents, 189(74.4%) were willing to work at the primary, 168(66.1%) chose to receive the economic incentives specifically for working at the primary, and 148 people(58.3%) hoped to receive such economic incentives immediately. Education background, self-rated economic income level of doctors and different payment methods of economic incentive for working at the primary had significant effects on their willingness to work at the primary( P<0.05). Conclusions:The current economic incentive policy of the alliance can meet the demands for economic incentives in terms of doctors′ material accounts, and doctors′ overall inclination to work at the primary was strong. If the amount of economic incentives is constant, doctors preferred to receive the economic incentives specifically, mainly affected by income accounts and additional income accounts. In addition, education and self-assessment of economic income level were important factors affecting the willingness of doctors to work at the primary, which may be affected by mental accounts other than material accounts.

Luohu District of Shenzhen has implemented the global budget management mode as " surplus reward, no compensation for overspending and reasonable sharing" in the hospital group, which continued to strengthen cooperation, optimize services, reduce costs, and improve health outcomes. The authors employed the game theory to build a game model of medical alliance under Luohu global budget management mode, discussing the reasons of medical and health institution′s stronger cooperation and what could be improved in Luohu′s case. Based on the experience of Luohu total budget management, it is suggested that when implementing total budget, all localities should improve closed-loop management, expand coverage, adopt compound medical insurance payment method, promote outpatient coordination, strengthen assessment and incentives, so as to give full play to the incentive role of total budget.

Objective To explore the clinical pathological characteristics of breast solid papillary carcino-ma(SPC). Methods The clinical manifestation,pathology morphology,immunohistochemical characteristics and prognosis of 23 cases with SPC was reviewed. Results There were 16 cases with nipple discharge as the chief com-plaint while 7 cases were mass. 10 cases of ultrasonic examination showed 6 cases(60%)were above BI-RADS grade 4 while 8/13 in X-ray examination. In 8 cases of SPC with invasion,5 cases were luminal A and 3 cases were lumi-nal B. There were no significant differences in the mean age,mean diameter of the mass,neuroendocrine markers (CgA and Syn)and proliferation marker Ki67 between in situ SPC group and invasive SPC group(P > 0.05). The difference between P63 and CK5/6 was statistically significant(P = 0.001,P = 0.019). No recurrence was found in 21 patients. Conclusions SPC is a rare type of breast cancer with good prognosis. Imaging and ductosco-py are easy to make under-diagnosis while pathology is likely to make misdiagnosis,therefore clinical pathologists should pay more attention so as to treat it more accurately.

Objective To analyze the basics and influencing factors for the medical expenditure of poor patients of tumor and end-stage renal diseases in Hubei province,and put forward policy recommendations for the critical illness insurance and health poverty alleviation.Methods 535 patients with tumor and end-stage renal diseases in Wuhan,Xiangyan and Shiyan in Hubei province were selected for a questionnaire survey,with 415 of the questionnaires subject to data analysis.Single factor variance analysis and multiple linear regression were used to analyze the influencing factors for their medical expenditure.Results 83.9% of the patients held their medical costs as too high;84.6% of them complaining significant drop of their annual family income due to their diseases; disposable household income of urban patients higher than their rural counterparts both before and after their disease; types of medical insurance and diseases are significant influencing factors for medical expenditure.Conclusions Poverty rate is high among patients of such patients.To reduce their financial burden,the government is recommended to cover more major diseases,enhance support for those of critical illness and improve the medical assistance system.