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.

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.

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.

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 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.