The quality of clinical practice teaching is an important factor affecting the quality of intensive care unit (ICU) specialist nurse training. We investigated the current situation of ICU specialist nurse training and teaching quality evaluation in China and around the world. There are several aspects that can be improved in the evaluation of the quality of clinical practice teaching for ICU specialist nurses in China. Result-oriented summative evaluation is mainly used in China, and there are few studies on the quality evaluation of clinical practice teaching process. Effective feedback mechanism has not been established for teaching quality evaluation. There is a lack of systematic theoretical guidance and few studies have been conducted on the formation of the quality of clinical practice teaching and the affecting factors. Therefore, there is an urgent need to construct a set of scientific and practical clinical practice teaching quality evaluation system for ICU specialist nurses under the guidance of systematic theory and in line with China's national conditions. We should formulate reasonable and uniform quality evaluation standards for clinical practice teaching, strengthen the quality evaluation of the training process on the basis of result-oriented quality evaluation. Moreover, the needs of all parties in the evaluation system should be comprehensively evaluated to improve the quality of clinical practice teaching.

Objective:To study the influencing factors of doctors′ compliance intention towards clinical pathways at diagnosis-related groups(DRG) pilot hospitals, as a reference in advancing the development of critical pathways management and the transition of DRG payment methods from pilot exploration to actual payment.Methods:With purposive sampling method, an online questionnaire survey was conducted on doctors at 4 tertiary hospitals involved in the DRG pilot in Wuhan from December 2020 to February 2021. The questionnaire covered doctors′ basic personal information, identification degree of three dimensions based on the theory of planned behavior, as well as their past compliance behavior and compliance willingness of clinical pathways. The influence of different factors on doctors′ clinical path compliance intention was analyzed by Kruskal-Wallis test and Wilcoxon signed-rank test, and the ordered multi-class logistic regression analysis was used in multivariate analysis.Results:335 valid questionnaires were obtained, of which 205(61.2%) doctors had high willingness to follow clinical pathways. Such factors as degree of attention to peer doctors′ attitudes towards clinical pathways( OR=16.44), sufficient understanding of the documents( OR=14.91), the adaptation between information systems and clinical pathways( OR=12.54), sufficient learning resources( OR=9.42), and high enrollment rate of their patients in charge in the past six months( OR=5.77), could positively affect the doctors′ willingness to follow clinical pathways. The high enrollment completion rate of patients cared by doctors in the past six months( OR=0.09) and the high mutation rate caused by medical prescriptions( OR=0.00) negatively affected doctors′ compliance intention towards clinical pathway. Conclusions:Most doctors at DRG pilot hospitals had high willingness to comply with the clinical pathways. The main factors affecting their willingness to follow the clinical pathway include, previous relevant work experience, the attitude of peer doctors, and support resources. To increase doctors′ compliance willingness towards clinical pathway, it is necessary to speed up the DRG payment process, adopt a flexible management model, enhance the sense of participation of doctors, and ensure adequate support vesources.

Objective To study the quality of outpatient prescriptions for patients of different age groups at both township and village level,for the purpose of evaluating the outcomes and problems of the ongoing healthcare reform at primary levels.Methods 100 outpatient prescriptions of April 2015 were mechanically sampled randomly from two township hospitals and 8 village clinics in counties A and B in Hubei province.These prescriptions were analyzed for the drug count per prescription,percentage of intravenous prescriptions,that of antibiotics,that of hormones and average cost per prescription.Results At the township hospitals,the drug count per prescription(2.02)of county A was less than that of county B(3.26),while the percentage of intravenous prescriptions(30.30%),that of antibiotics(47.98%)and hormones(6.57%)of county A were significantly less than those of county B(50.65%,69.08% and 15.13% respectively).At village clinic level,the percentage of intravenous prescriptions(31.05%)of county A was higher than that of county B(20.34%),the average prescription costs(￥29.28)of county A was less than county B(￥31.45);while in terms of children′s prescriptions,average drug count of county A(2.50)was higher than county B(2.09),and its proportion of antibiotics(65.91%)was higher than county B(45.56%).Conclusions General primary care reform is faced with challenges of poor control of intravenous injection and use of antibiotics,particularly at village clinics and pediatric drug use in terms of prescription quality control.Both township and village levels should strengthen the supervision over the drug suppliers,guide the demand side to rationally use drugs and focus on the reasonableness of the medication of village clinics and children.

Objective By comparing the organ system based medical integration teaching mode and traditional teaching mode to evaluate the effect of the integration of curriculum implemen-tation. Methods Through a questionnaire survey of 63 students who implement integrated curriculum and 183 students who are not implementing integrated curriculum as well as 76 teachers, we evaluate students' emotional, cognitive and motor skills, using SPSS statistical analysis, chi-square test. Results In the affective domain, most of the teachers thought the experimental class was superior to the com-mon one in learning interest, lifelong learning and independent learning, critical thinking, the contrast of the two classes were P=0.000, P=0.031 and P=0.001 respectively, all of significant difference. In the cognitive domain, the contrast of the two classes in memory, understanding and application were P=0.000, all of significant difference. The experimental class has high degree of recognition. In the psychomotor domain, more than 55.3%(42/76) of the teachers thought that the experimental class was superior to the common class. According to the students' questionnaire survey, the contrast of the two classes in clinical operation skills, Interpersonal communication skills were P=0.077, P=0.031 respec-tively. There was no statistically significant difference. Conclusions The integrated curriculum teach-ing model can greatly promote students' abilities in most areas such as interest in learning, lifelong learning awareness, clinical thinking ability; interpersonal communication skills etc. In some respects the differences remains to be further studied such as memory of knowledge, systematic knowledge, and clinical operation skills, etc.

Objective To provide reference for focusing and improving policy efficiency in China by establishing the conceptual model and index system of effectiveness of Township and Village Health Services Integration Policy(TVI).Methods The conceptual model and index system of TVI effectiveness were established by literature review and Delphi method.Comprehensive Index Method and Weighted TOPSIS Method were used in index consistency check.Results The conceptual model and index system of TVI effectiveness contain four conceptual modules,8 policy goals and 27 evaluation indexes.The positive coefficient of experts is 0.95 and authoritative grades of experts are more than 0.90.Conclusion Based on SPO Model,the conceptual model and index system of TVI effectiveness in China have been established,which consists three aspects:construction of organization system,health services and satisfaction.

Objective To provide reference for improving the performance of public health by establishing performance evaluation framework of public health in rural areas of China.Methods The performance evaluation framework of public health in rural areas is established by literature research,theoretical derivation and Delphi method.The results of expert consultation are tested by W test of Kendall coordination coefficient and chi-square test.Results The performance evaluation framework of public health in rural areas contains four conceptual modules,ten performance goals and twenty-eight performance evaluation indexes.The positive coefficient of experts is 0.889.The average values of authoritative grade of experts are between 0.681～0.715.The Kendall W uniformity coefficients of the necessity,sensitivity and maneuverability of the indexes are respectively 0.167,0.209 and 0.185.The P values are less than 0.01.Conclusion The performance evaluation framework of public health in rural areas has certain application value.It is necessary to pay attention to scientific nature and applicability in developing performance evaluation of public health in rural areas.

For the purpose of resolving such current problems as low inclusion ratio and high exit ratio in the single-disease clinical pathway management,the paper proposed an idea of clinical pathways grouping management,in line with DRG management and based on traditional clinical pathway management practice and China' s conditions.Proposed in the paper are such measures for government service procurement,as quality control mechanism,price negotiation mechanism,performance-based payment mechanism,and supervision mechanism.These measures are designed to provide incentives for medical institutions and medical workers,control irrational rise of medical expense,optimize expense makeup,and improve both quality of care and patient satisfaction.Thanks to the China Rural Health Development Project in place in Henan province where DRG-based clinical pathway grouping management and government service procurement are in trials,the following outcomes are achieved.Namely,significant expansion of diseases coverage and population coverage,efficient control of per-patient/per-visit expenses,and a steady rise of surgery and treatment expenses which embody value of service of medical workers.Other benefits include 50％ to less than 30％drop of drugs proportion,gradual optimization of medical expenses makeup,obvious improvement of quality of care.These measures have made hospitals,insurance providers and patients satisfactory.

An analysis of the fundamental concepts for public hospital reform further defined public hospitals and other hospitals,business and non-business in nature,public benefits and welfare,as well as public benefits and profit-oriented hospitals.These distinctions can help reformers of public hospitals clarify their concepts,make clear the purpose and direction of the public hospitals reform,so as to speed up the reform with theory support.

This paper made systematic description of the three objectives of sustainable development designed for the policy based on the sustainability theory for the health sector.The essential drug system for secondary hospitals comprises the list coverage and allocation percentage of essential drugs,requirements for bidding and purchasing as well as pricing practice; management and conditions of these hospitals,including leadership determination and competency,doctors prescription behavior,and supportive reforms at these hospitals; external policies and social environment,including government financial subsidy,medical service prices adjustment,medical insurance,and the awareness and attitude of the people on essential drugs.

This paper studied the development stages in terms of the public nature of public hospitals in China and analyzed the causes for their weakened public benefits.It proposed the principle of government guidance,achieving government purchasing of healthcare services as the roadmap,as well as building and improving the service purchasing system,performance appraisal system,and payment review system along with supervision system.These measures are designed to make public hospitals in their public benefit nature with scientific system design,powerful institutional guarantee,and efficient execution strategies.