Background Urban community health services are key to promoting the high-quality development of community health. However, previous studies have seldom explored the evolutionary logic and development trend of community health service policies. It is difficult to provide a comprehensive answer to the questions of the generation, evolution and trend of community health service policies in China. Objective To understand the current status, evolutionary logic and trend of community health service policies, in order to provide intellectual reference for promoting the high-quality development of community health services and implementing the hierarchical diagnosis and treatment system. Methods The Central People's Government website, National Health Commission, relevant official provincial websites, CNKI, China Community Health Association and other platforms were searched from December 2019 to March 2022 for community health service reform related policies published at national level (n=98) from January 1997 to March 2022. The included policies were analyzed with the help of the policy orientation analysis model. Results The policy changes in urban community health services of China have gone through four stages since 1997, including initial exploration centered on the transformation and frame construction (from 1997 to 2002), normative construction focusing on the bottom of the public health network (from 2003 to 2008), prosperous development focusing on the mechanism reform (from 2009 to 2016), and deepening reform centered on quality improvement and empowerment (from 2017 to 2022). The changes in community health service policies in China follows the following evolutionary logic, including the dynamic mechanism from marketization to professionalization and social community linkage governance, target orientation from scale expansion to internal quality improvement, policy discourse changing from predominantly economics-based discourse to multiple tools coordination. Conclusion Community health service policies should promote the innovation of the dual collaborative governance framework and mechanism, strengthen the coordination among professional systems and their effective synergistic linkage with the social community governance systems; promote community value-based health care and trust-based health care with health as the core, establish and improve evaluation standards for the capacity and quality of specialized primary care; promote the diversified application and matching of policy tools to adapt to the diversified needs of community health and wellness interests.

Objective:To build a performance evaluation index system of family doctor contracting service for urban communities, so as to evaluate the effects of such service.Methods:Based on the conceptual framework of performance appraisal of family doctor contracting service, such means as Delphi method and analytic hierarchy process were employed to evaluate the performance appraisal system of such service. A measured simulation test was made in Guangzhou.Results:A library of performance appraisal candidate indexes for such service was established, based on the performance appraisal concept framework of " structure, input, output, result" of such service. A questionnaire made based on such a library was developed for correspondence inquiry of 20 experts from December 2018 to June 2019. Based on results of such inquiry, a performance appraisal system for family doctor contracting service in Guangzhou was developed, consisting of 4 level-1 indexes, 10 level-2 indexes and 34 level-3 indexes. In the system, level indexes include organizational structure and management(weight 0.21), resource input(weight 0.24), contracting service process(weight 0.19), and contracting service effect(weight 0.36). A community health center in Guangzhou was used as the measurement site, for adjustment and improvement of data acquisition methods of individual indexes or scoring criteria.Conclusions:The index system is developed scientifically; appraisal tools are designed focusing on results and outputs, ensuring the appraisal of contracting service quality from multiple perspectives of supply-demand sides and health management patterns; the system can provide appraisal tools for policy appraisal authorities to evaluate the performance of contracting service reform.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:了解我国家庭医生签约服务绩效评价研究现状。方法:系统检索中国生物医学文献数据库、中国知网、万方数据知识服务平台等关于家庭医生签约服务绩效评价的文献,检索时间限定为2008年1月-2018年11月。运用文献计量法和内容分析法对纳入文献进行资料分析。结果:最终纳入分析的文献有29篇。第一作者工作单位为高校和科研机构、政府管理部门、基层医疗卫生服务机构的分别为16篇（55.17%）、3篇（10.34%）、10篇（34.48%）;发表于核心期刊的文献为11篇（68.75%）,其中《中国全科医学》占5篇（31.25%）;华东地区高校学位论文数量最多,为8篇（61.54%）。家庭医生签约服务产出评价以服务数量、质量、费用、可及性等方面为主;签约服务结果评价以签约居民的健康状况改善、健康和就医行为的变化及供需方的满意度测量方面为主。文献调研法和德尔菲法是研究使用频次最高的方法,确定权重方法使用较多的是层次分析法和百分权重法。结论:斟酌评价指标的合理性和可操作性;组合使用评价方法;绩效评价研究可在评价内容、模式、指标目标值及方向上继续深入探索。</span>

家庭医生签约服务的发展需要卫生服务系统各个环节的协同和支持,县(区)域医疗中心是县域医疗卫生服务体系龙头,聚集了区域优质医疗资源,是县域家庭医生签约服务工作的重要支撑.本文从价值链和利益相关者的角度进行分析,明确了县(区)域医疗中心在家庭医生签约服务发展中发挥的作用分别是:县域家庭医生签约服务的医疗技术支撑平台;县域家庭医生团队的培训主体;县域家庭医生团队优质医疗资源的供给者;连续性家庭医生签约服务的供给环节之一;进一步使县(区)域医疗中心在家庭医生签约服务开展过程中充分发挥作用,进而促进县(区)域医疗中心和县域家医服务的协同发展.

通过对当前卫生领域常用绩效评价概念框架进行比较总结,理清家庭医生签约服务绩效评价概念框架的构建思路,明确概念框架的内容,将家庭医生签约服务绩效评价的框架概念化为结构、投入、过程、产出、结果5个维度,并从供需方角度区分家庭医生签约服务的产出、结果.该概念框架可为建立科学的家庭医生签约服务绩效管理机制提供思路.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:根据大学排名分析医药类院校的竞争力水平,探究其存在的问题与发展对策。方法:基于指标体系归纳软科中国最好大学排名的价值取向,并结合2017年的排名数据进行统计分析。结果:医药类院校在全国、省域中的排名普遍落后,科技创新的质量和产学研合作的效益是多数医药类院校的短板。结论:为提升竞争实力,医药类院校可以在大学排名的评价框架下优化发展策略;政府部门也应实施政策扶持,推动医药类院校实现内涵式发展。</span>

目的探讨县（区）域医疗中心医务人员对双向转诊服务的意愿及其影响因素。方法采用简单随机抽样对广州某县（区）域医疗中心的214名医务人员进行问卷调查。结果 84. 6%（181/214）医务人员愿意转诊患者。多因素Logistic回归分析显示,了解（OR=1. 32,95%CI:1. 12～1. 89,P=0. 028）和非常了解转诊流程和标准（OR=2. 58,95%CI:1. 75～3. 26,P ＜0. 001）、下级医院及患者配合（OR=2. 93,95%CI:1. 72～4. 98,P ＜0. 001）和非常配合（OR=3. 53,95%CI:2. 12～5. 38,P ＜0. 001）、不影响医院业务绩效（OR=1. 72,95%CI:1. 21～3. 86,P=0. 014）以及有明确的转诊标准和制度（OR=2. 04,95%CI:1. 67～3. 57,P ＜0. 001）的医务人员转诊意愿较高,差异有统计学意义（P ＜0. 05）。结论加强转诊的宣传力度,提高医务人员对双向转诊了解程度、制定明确的转诊标准和制度有利于提高医务人员转诊意愿。