Objective:To explore the core issues in the implementation of"packaged payment"in China's compact county medi-cal community,in order to provide useful references for the innovative reform of medical insurance payment methods in compact coun-ty medical community.Methods:By constructing the problem system through the macro model of the health system,analyzing the re-lated literature using multidimensional scale analysis and social network analysis,and comprehensively evaluating the results using the entropy-weighted TOPSIS method,it summarizes the core issues of"packaged payment"in compact county medical community.Results:There are core issues in China's compact county medical community,such as inadequate distribution of benefits and incen-tive and constraint mechanisms within the medical community(Ci= 1.000),lack of effective supervision and assessment mechanism for medical communities(Ci= 0.732),suppressed quality and efficiency of medical services(Ci= 0.652),lagging medical informatiza-tion construction(Ci= 0.595),and incomplete supporting policy measures(Ci= 0.579).Conclusion:The"packaged payment"of com-pact county medical community can be optimized from the following three aspects:a multi-level collaborative incentive mechanism should be improved to ensure the service quality and efficiency;optimize the total amount calculation method and improve the de-tailed supporting measures;accelerate information construction and strengthen supervision and assessment management.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To explore the leading role and influence path of the coordinated development of the tight medical community service capacity and the high level of county economy,so as to provide a basis for its deepening reform and long-term development.Methods:Taking 39 pilot compact medical communities in Guangxi in 2022 as research samples,from the perspective of set and whole,the coupling coordination degree model and fuzzy set qualitative comparative analysis were used to analyze the coordinated development status and influence mechanism of their service capacity and county economic level.Results:High-level county economic structure is a necessary condition to promote coupling and coordinated development.Among the six configuration paths that affect the improvement of coupling and coordination degree,the core conditions are stable county economic foundation and sufficient health human resources or(and)health financial resources.The overall solution consistency is 0.996(≥0.8),and the coverage is 0.780(≥0.5).The model has strong explanatory power.Conclusion:Multi-factor internal and external cooperation to promote the coordinated development of the service capacity of the compact medical community and the county economy should focus on the county economic foundation and structure,further improve the income of the compact medical community and pay attention to the optimization and expansion of the talent team.

Objective:To compare the efficacy of cervical decompression performed at different times in the treatment of incomplete cervical spinal cord injury.Methods:A multicenter retrospective cohort study was conducted to analyze the clinical data of 96 patients with incomplete cervical spinal cord injury admitted to six hospitals including Honghui Hospital affiliated to Xi'an Jiaotong University, etc, from May 2018 to May 2021. There were 36 females and 60 males, aged 28-42 years [(35.2±6.7)years]. The injured segments were at C 3 in 7 patients, C 4 in 15, C 5 in 20, C 6 in 23 and C 7 in 31. According to the American Spinal Injury Association (ASIA) scale, there were 59 patients with grade B, 27 grade C, and 10 grade D. A total of 36 patients underwent cervical decompression within 24 hours after injury (early group), 33 patients within 24-72 hours after injury (late group), and 27 patients within 4-14 days after injury (delayed group). The operation time, intraoperative blood loss, postoperative drainage, length of hospital stay, Cobb angle, height of intervertebral space and space occupation of the spinal canal before surgery and at postoperative 3 days, and ASIA score, ASIA motor score, ASIA light tactile score, ASIA acupuncture sensation score, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, neck dysfunction index (NDI) before surgery and at postoperative 3 months, 1 year and at the last follow-up and incidence of complications were compared among the three groups. Results:All the patients were followed up for 12-21 months [(16.4±4.2)months]. There was no significant difference in the operation time among the three groups (all P>0.05). The intraoperative blood loss and postoperative drainage volume in the early group were (312.5±5.2)ml and (165.3±45.8)ml, which were higher than those in the late group [(253.5±40.0)ml, (120.4±60.6)ml] and the delayed group [(267.3±36.8)ml and (130.4±38.6)ml] (all P<0.01). There was no significant difference between the late group and the delayed group (all P>0.05). The length of hospital stay in the early group was (5.2±1.6)days, which was shorter than that in the late group [(7.6±2.3)days] and the delayed group [(8.0±1.3)days] (all P<0.05), but there was no significant difference between the late group and the delayed group ( P>0.05). There was no significant difference in the Cobb angle, height of intervertebral space and space occupation of the spinal canal among the three groups before and at postoperative 3 days (all P>0.05). There was no significant difference in the ASIA score, ASIA motor score, ASIA light tactile score, ASIA acupuncture sensation score, VAS score, JOA score and NDI among the three groups before surgery (all P>0.05). At postoperative 3 months, 1 year and at the last follow-up, the ASIA grading of the early group was better than that of the late group and the delayed group ( P<0.05 or 0.01), but there was no statistically significant difference between the late group and the delayed group (all P>0.05). The ASIA motor scores of the early group were (56.4±4.5)points, (76.3±3.6)points and (85.4±6.5)points at postoperative 3 months, postoperative 1 year and the last follow-up, respectively, which were higher than those in the late group [(52.3±2.4)points, (60.3±8.6)points and (72.3±2.4)points] and the delayed group [(51.9±2.3)points, (62.8±4.6)points and (71.9±1.3)points]; the ASIA light tactile scores of the early group were (70.2±2.9)points, (72.6±4.3)points and (78.3±2.3)points, which were higher than those in the late group [(66.2±3.7)points, (68.3±1.6)points and (73.3±1.6)points] and the delayed group [(65.2±2.1)points, (67.8±1.9)points and (72.3±2.5)points]; acupuncture sensation scores of the early group were (71.9±3.1)points, (80.1±3.8)points and (89.1±7.6)points, which were higher than those in the late group [(67.4±2.7)points, (72.6±3.7)points and (77.9±1.8)points] and the delayed group [(68.3±2.2)points, (72.6±3.1)points and (77.2±1.9)points] (all P<0.05). VAS scores of the early group at postoperative 3 months, 1 year and at the last follow-up were (4.3±0.6)points, (2.4±0.3)points and (1.6±0.2)points, which were lower than those in the late group [(5.1±1.3)points, (4.1±0.6)points and (3.0±0.6)points] and the delayed group [(5.0±1.7)points, (4.0±0.8)points and (3.1±0.2)points]; JOA scores of the early group were (12.8±1.6)points, (14.4±2.6)points and (17.9±3.3)points, which were higher than those in the late group [(11.9±1.9)points, (13.3±1.6)points and (8.9±1.3)points] and the delayed group [(11.6±1.8)points, (13.2±1.4)points and (9.3±2.1)points]; NDI scores of the early group were 12.1±3.3, 10.1±2.1 and 7.3±1.4, which were lower than those in the late group (14.4±3.1, 12.3±1.6 and 8.9±1.3) and the delayed group (14.1±2.3, 12.9±1.9 and 9.5±2.1) (all P<0.05). There was no significant difference in all the above-mentioned scores at postoperative 3 months, 1 year and at the last follow-up between the late group and the delayed group (all P>0.05). The incidence of complications was 25.0% (9/36) in the early group, 27.3% (9/33) in the late group and 37.0% (10/27) in the delayed group (all P>0.05). Conclusion:Compared with within 24-72 hours and 4-14 days after injury, cervical decompression performed within 24 hours after injury for patients with incomplete cervical spinal cord injury can shorten the length of hospital stay, improve the function of the spinal cord nerves and relieve pain, with no increase of the incidence of complications.