ObjectiveTo analyze the changes in the degree of coordination of China's major epidemic prevention and control efforts before and after the outbreak of the Corona Virus Disease 2019 (COVID-19), so as to explore the impact of epidemic prevention and control measures on coordination dynamics. MethodsA total of 3 864 policy documents related to epidemic prevention and control from January 2000 to December 2020 across 31 provinces (autonomous regions, and municipalities) in China were systematically collected. Contents specific to collaborative and cooperative efforts were extracted, and the extent of interdepartmental coordination were quantified to assess the effectiveness of epidemic prevention and control efforts. Wilcoxon signed-rank test was adopted to statistically analyze the differences between the indicators before and after the epidemic. ResultsThe average overall coordination level for major epidemic prevention and control in 31 provinces (autonomous regions, and municipalities) increased from 43.06% to 97.62%, and the average coordination levels in the eastern, central, and western China soared from 42.29%, 37.50%, and 47.46%, to 98.81%, 96.20%, and 97.46%, respectively, with statistically significant differences (all P<0.05). In terms of department categorization, coordination levels in the professional departments and the key support departments peaked at 100.00%, while other support departments rose to 95.43%, with an increase of 77.15%, 181.85%, and 139.89%, respectively, exhibiting noteworthy statistically significant differences (all P<0.001). ConclusionThe scope of coordination departments of China’s major epidemic prevention and control exists a remarkable surge following the COVID-19 outbreak, notable heightened coordination is particularly observed among the key support departments. Future endeavors should prioritize the roles played by diverse departments in epidemic prevention and control, enhancing both the clarity of departmental responsibilities and the effectiveness of interdepartmental coordination.

ObjectiveTo systematically evaluate the public health governance capacity of 40 cities in Jiangsu, Zhejiang, and Anhui Provinces, providing a scientific evaluation basis for building a "Healthy Yangtze River Delta". MethodsA comprehensive collection of policy documents, public information reports, and research literature related to public health governance capacity in Jiangsu, Zhejiang, and Anhui Provinces was conducted, totaling 6 920 policy documents, 1 720 information reports, and 1 200 literature pieces. Based on the evaluation standards for an appropriate public health system established by the research team, the basic status of public health governance capacity was assessed to identify the strengths and weaknesses of the 40 cities. ResultsIn 2022, the public health governance capacity score for the 40 cities in Jiangsu, Zhejiang, and Anhui Provinces was (562.5±38.0) points. In terms of specific areas, the emergency response field received the highest score of (791.4±49.7) points, while the chronic disease prevention and control field received the lowest score of (368.2±29.6) points. The Jiangsu-Zhejiang-Anhui region has largely achieved the strategic priority of health, gradually improved public health legal regulations, and established a basic organizational framework with a solid foundation for information and data infrastructure. However, challenges still need to be addressed, such as unstable government funding for public health, unclear departmental responsibilities, and barriers to information interoperability. ConclusionThe public health governance capacity of the 40 cities in Jiangsu, Zhejiang, and Anhui Province has been at a moderate level, but disparities have still existed across regions and fields. In the future, while continuing to deepen existing advantages, it is essential to accurately identify the causes of problems, establish a long-term and stable investment mechanism, enhance information connectivity mechanisms, further clarify departmental responsibilities, and promote the achievement of the "Healthy Yangtze River Delta" goal.

Objective:To compare the social support levels as understood by family doctor team members in township hospitals/community health centers, and village clinics/community clinics, and their influencing factors, in order to provide reference for improving the work status of family doctor team members and enhancing the quality of family doctors′ contracted services.Methods:A multi-stage random cluster sampling method was used to sample medical workers from contracted family doctor teams in township hospitals/community health centers and their subordinate village clinics/community clinics in 6 counties (cities, districts) of Tai′an city, Shandong province. In August 2020, a questionnaire survey was conducted on the perceived level of social support among family doctor team members using the perceived social support scale. Descriptive analysis was conducted on the data, and independent sample t-tests and one-way ANOVA were used to conduct univariate analysis on the influencing factors of perceived social support scores of family doctor team members at different levels, while multiple linear regression analysis was used to conduct multivariate analysis. Results:A total of 765 valid questionnaires were collected, with 203 and 562 from township hospitals/community health centers and village clinics/community clinics, respectively. The total perceived social support scores of family doctor team members in township hospitals/community health centers and village clinics/community clinics were (65.56±10.29) and (67.31±10.14), respectively, featuring statistically significant differences ( t=-2.11, P<0.05). In-mirage marital status ( β=0.18, P=0.008), good/very good self-rated health status ( β= 0.25, P=0.048), participation of work-related training within one year ( β=0.17, P=0.010), relatively satisfied/very satisfied for job promotion ( β= 0.17, P=0.046), as well as above/far above average self-rated economic status as ( β=-0.15, P=0.027), were the influencing factor on the perceived social support scores of family doctor team members in township hospitals/community health centers. In-marriage marital status ( β= 0.12, P=0.002), good/very good self-rated health status ( β=0.14, P=0.026), junior or intermediate level or above professional title ( β=-0.11, P=0.003; β=-0.10, P=0.006), participation of work-related training within one year ( β= 0.14, P<0.001), and relatively satisfied/very satisfied for job promotion ( β= 0.16, P<0.001) were the influencing factors on the perceived social support scores of family doctor team members in village clinics/community clinics. Conclusions:Members of the family doctor teams in primary medical institutions in Tai′an city had a higher level of understanding of social support. There were differences in the social support levels of family doctor team members between the two levels of primary medical and health care institutions, and the influencing factors were not completely consistent. Targeted measures should be taken based on specific circumstances to enable them to better receive and perceive support from family and friends, and to improve the quality of family doctors′ contracted services.

Building a strong public health system has become an urgent task in the new era. Based on more than eight years of systematic research， we believe that five aspects need to be prioritized for a strong system. First， we should change the perspective on public health， using the word “gonggong jiankang” to replace “gonggong weisheng” and the word “gonggong jiankang tixi” to replace “gonggong weisheng tixi”， to lead the public health system development. Second， we should develop a suitable public health system and continuously improve the health capacity for governance. Third， we should make it clear that the goal of building a strong system is not far-fetched， and we need to consolidate the existing institutional advantages of China’s public health system： when encountering major problems， we can maintain a unified goal and mobilize the whole society to cooperate effectively to accomplish the goal. However， we need to make up for shortcomings one by one， especially to solve the key problem of lacking a strong coordination mechanism in daily work. Fourth， we should pursue excellence and consolidate the“suitable” mechanism proven in the process of coping with the COVID-19， so that efficient mechanisms to deal with major issues can be used in routine work， and efforts should be made to consolidate the advantages of prevention and control of infectious diseases and emergency response，so as to achieve the balanced development of regions categories and units.Finally， it is necessary to strengthen the coordination of government and research institutions， in the aspects of technological innovation， talent team building and accurate consulting services， and work together to pursue a suitable and strong system to realize the modernization of the health system and capacity for governance.

Objective:To explore the aging care willingness and requirements for long-term care services among elderlies with different activity of living(ADL).Methods:7 070 elderlies aged 60 years and above were subject to a questionnaire survey using stratified multistage random cluster sampling in three municipalities of Shandong province from August through September, 2017. Data information was obtained by a customized questionnaire and ADL scale. Rank sum test and multivariate logistic regression were used for statistical analysis.Results:According to the ADL scoring, the participants were divided into 3 groups: normal, decreased function, and dysfunction, with 5 467(77.3%), 1 283(18.2%), and 320(4.5%)people respectively. Elderlies with different ADL had different aging care willingness, and the difference was statistically significant( Z=8.704, P<0.05). The factors influencing long-term care services need varied with the degree of ADL. The willingness was a common factor for long-term care services needs of the three elderly groups. The age and living arrangements were factors among the normal ADL group. The living arrangements and chronic diseases were those among the decreased function group, and the education and self-rated economic status were those among the dysfunction group. Conclusions:The demand for long-term care service were diversified with the degree of ADL. Targeted interventions should be taken to meet the needs of elderlies of different ADL.

Objective:To investigate the middle-aged and elderly people′ willingness for family doctor service contracts and its influencing factors, and to provide feasible suggestions for the implementation and promotion of family doctor services.Methods:Stratified random sampling method was adopted to select middle-aged and elderly people aged 45 in 6 urban areas of Xuzhou city for questionnaire survey to investigate their illness, medical treatment and their willingness to contract a family doctor. The data acquired were analyzed with statistical description, univariate analysis( χ2 test), and multivariate logistic regression analysis. Results:Among the 927 valid questionnaires were recovered, 272(29.34%)of them intended to contract a family doctor, and 655(70.66%)had no such intention. Results of multivariate logistic regression showed that the influencing factors of the middle-aged and elderly people′ willingness of contracting family doctors were age, occupation, self-rated health, treatment status within two weeks, chronic diseases, referral experience and their knowledge of family physician contract system.Conclusions:Middle-aged and elderly people at large are not willing to sign up for family doctors. It is recommended to focus the publicity efforts on those who are relatively younger age, farming and healthier, enhancing their awareness of the service, and encouraging them to support the dual-referral policy. These efforts are expected to promote the coordinated progress of both dual referral and family doctor contract service, hence achieving the national coverage of the family doctor system.

Objective: To investigate the utilization of inpatient health care among the elderlies in Shandong province, and to analyze the factors affecting the inpatient services utilization, so as to provide reference for the elderlies to utilize the inpatient services reasonably. Methods: The survey was conducted in Shandong province in August 2017. Multi-stage stratified cluster random sampling method was used to select 7 070 residents aged 60 and above in 6 counties and districts of Shandong province as the objects of the survey. The survey included the basic family and personal information of the elderlies as well as the utilization of hospitalization services. Chi-square test and rank sum test were used for univariate analysis, and logistic regression was applied for influencing factors. Results: The annual hospitalization rate of the elderlies in Shandong province was 18.1%, and 9.6% of those in need of hospitalization failed to enjoy the service. The annual hospitalization rate of the elderlies aged 80 years and over was 19.9%, and 5.5% of the patients in need had not been hospitalized. Among the inpatient institutions, the proportion of township health centers/community health service centers, county-level(district) medical institutions, prefecture-level medical institutions and provincial-level medical institutions was 29.2%, 29.1%, 37.7% and 1.4%, respectively.Factors influencing the utilization of hospitalization services for the elderlies included age, self-assessment of health, physical examination, chronic diseases, type of medical insurance and income level. Conclusions More attention should be paid to the hospitalization services for the elderlies aged 80 years and over. Effective measures should be taken to guide the elderlies to fully use primary medical resources. The prevention and control of chronic diseases should be strengthened to promote the rational use of inpatient health services among the elderlies. In addition, more attention should be paid to low-income elderlies to meet their hospitalization needs.

Objective: To understand the referral status and the willingness for downward referral among rural elderlies with hospital stay experiences in the past year in Shandong province, and to explore its influencing factors on the willingness for downward referral. Methods: Three prefecture-level cities in Shandong province were sampled by multi-stage stratified random sampling in August 2017. Questionnaire survey was conducted among 910 rural elderlies(over 60 years old)who had been hospitalized in the past year. The study included the basic information, the hospitalization experience, and perception of essential medicines system, ego-resiliency, the referral status and willingness for downward referral. Rank sum test, Chi-square test and t test were used for univariate analysis, and logistic regression was applied for influencing factors. Results: Among 910 rural elderlies who had been hospitalized in the past year, 53(5.8%) were referred to other medical institutions in their recent hospitalization, and 597(65.6%)were willing to be referred downward. The main reason for their reluctance for downward referral was that the medical competency of primary medical institutions was low; and the main reason for willingness for downward referral was being close to home. The results showed that marital status, impression for the national essential medicines system and ego-resiliency were the influencing factors of their willingness to downward referral among rural elderlies who had been hospitalized in the past year(P<0.05). Conclusions The referral rate and willingness for downward referral among the rural elderlies in Shandong province are relatively low. We should further enhance the service capacity of primary medical institutions, strengthen the publicity and implementation of the national essential medicines system, pay attention to help with the elderlies′ negative emotions caused by diseases, and improve their ego-resiliency.

Objective To measure and evaluate the construction of hospital safety culture, analyze the present situation and problems of hospital safety culture construction, and put forward strategy of continuous improvement. Methods Based A tertiary hospital in northern Jiangsu province was chosen for the survey. Sampling questionnaire survey was made to 400 staff of the hospital, including directors/vice directors of clinical departments, chief nurses and logistic/administrative staff(10％ of the total staff). These people were subject to a questionnaire survey of Hospital Safety Culture Measurement regarding hospital safety culture status and satisfaction. Likert 5-point scale and assign points, statistical inference, and quality control chart method were used, to analyze the organization structure, medical quality and medical safety, comprehensive evaluation dimensions of hospital safety culture, as well as 31 items involved. Results The agreement/satisfaction scoring of the general evaluation dimension of hospital safety culture was 67. 10％ as in agreement and 23. 20％ as high agreement; the scoring of the organization structure ( management capability of department managers and medical worker staffing) and medical safety( failure to report adverse events and discussion of patient privacy ) for hospital safety culture development was low ( 3. 4167 and 3. 5009 respectively). This calls for improvement. Conclusions The hospital should perform continuous monitoring and improvement, and strengthen the organizational work of safety culture hospital wide ( especially department managers) . It should also enhance the management of medical quality( ensuring drug supply, and service management awareness of logistic departments), and pay attention to medical safety monitoring and management for higher responsiveness of the hospital.

Objective: To learn the impact of abolishing medicine markups on the revenue structure of public hospitals in Qingdao city. Methods: The business performance of 12 public hospitals directly under the Qingdao Health and Family Planning Commission was analyzed to compare their revenue structure the year before (July 2015 to June 2016) and the year since the reform (July 2016 to June 2017). Results: The reform has witnessed increased government subsidies, and decreased revenue from drugs and healthcare materials. For example, the proportion of drug expenditure decreased from 44.21% to 32.71%, while the proportion of medical service income and that of examination and laboratory examination increased to some extent. Conclusions Given the initial success of the reform, challenges remain in further curbing revenues from examinations and checkups, and growing revenue from TCM drugs as well.