Background: Community rehabilitation is central to continuity of care, yet average citywide provision may conceal substantial local inequalities. Shanghai has expanded demonstration community rehabilitation centres since 2021. We assessed changes associated with this programme and examined variation between urban and suburban areas and across six administrative districts. Methods: We conducted a longitudinal observational study of 48 community rehabilitation centres in Fengxian, Jiading, Jing'an, Minhang, Putuo and Xuhui districts from 2020 to 2024, comprising 240 centre-year observations. Service capacity was evaluated with an 85-indicator structure-process-outcome framework. Indicator weights were derived objectively by the entropy method, and a technique for order preference by similarity to ideal solution (TOPSIS) closeness coefficient was calculated for each centre-year. Paired t tests, independent-samples t tests and one-way analysis of variance with least significant difference post-hoc comparisons were used for subgroup analyses. Results: Among 32 demonstration centres, the mean closeness coefficient increased from 0.27 (SD 0.07) before construction to 0.30 (SD 0.05) afterwards (P < 0.001; Cohen's d = 1.21). The change among 16 non-demonstration centres was smaller and did not reach statistical significance (0.20 [SD 0.06] to 0.22 [SD 0.06]; P = 0.051). There was no statistically significant urban–suburban difference in any study year (all P > 0.05). District-level differences were present throughout 2020-2024 (all P < 0.05). Jing'an had the highest mean coefficient in 2024 (0.34 [SD 0.07]), whereas Fengxian remained lowest (0.22 [SD 0.06]). Putuo performed strongly in 2020-2021 but its advantage weakened after 2022, alongside marked volatility in equipment investment, outpatient activity, home-based rehabilitation and research output. Conclusions: Improvements in service capacity were associated with participation in Shanghai's demonstration-centre programme. The absence of an overall urban-suburban difference did not imply geographic equity: persistent differences between districts remained. Municipal monitoring should therefore combine citywide standards with district-specific support, stable investment and stronger referral and workforce arrangements.

Background:China is one of the countries with the largest number of patients with homozygous familial hypercholesterolemia (HoFH) in the world. Improving the quality of life and health outcomes for HoFH patients in China is of great importance. Therefore, the aim of this study is to assess the quality of life of HoFH patients in China and to investigate the factors that influence quality of life. Methods:Data were obtained from a national epidemiological survey of HoFH patients conducted by Beijing Anzhen Hospital, affiliated with Capital Medical University, during 2017-2019. The questionnaire included patient demographic information, disease information, family economic status and health-related quality of life. Quality of life was assessed using the EuroQol five-dimension three-level (EQ-5D-3L) questionnaire. Data processing and statistic tests are performed using Python libraries. Results:This investigation incorporated a sample size of 53 patients diagnosed with HoFH, with an average age of 27.92 years. It was observed that 45.28% of these patients' families were subjected to catastrophic health expenditure. The mean and median health utility scores were calculated to be 0.849 and 0.875, respectively, a figure that is significantly lower when compared to the scores of the general population. Furthermore, it was noted that 52.83% of the patients exhibited some level of difficulty or extreme difficulty in at least one dimension of the EQ-5D-3L. Significant Factors negatively affecting the quality of life of HoFH patients include the presence of atherosclerotic cardiovascular disease (ASCVD), hospitalisation in the past year, taking multiple medications, higher than average healthcare expenditure per capita, catastrophic healthcare expenditure and debt due to HoFH. After application of Benjamini-Hochberg method to minimize type 1 error, the occurrence of ASCVD and debt due to HoFH are likely to exert the most significant influence. Substantial relevance of the two factors are also evidenced by large effect sizes and adequate statistical power. Conclusions:Chinese patients with HoFH showed lower quality of life than the general population. Policy makers should consider the policy that improves early diagnosis, employment prospects, and the availability of HoFH-related interventions and provision of financial assistance for patients suffering from HoFH.

Background: Palliative care plays a vital role in enhancing the quality of life of older adults with chronic diseases, while service coverage in China remains limited. Shanghai faces increasing demand due to its rapidly aging population and high prevalence of chronic diseases. However, little is known about the needs, influencing factors, and care preferences of community-dwelling older adults. This study aimed to assess palliative care needs in this population and to identify associated determinants and care preferences. Methods: A cross-sectional survey was conducted among community-dwelling older adults with chronic diseases in Shanghai. Data on sociodemographic information, palliative care needs and preferences were collected. Descriptive analyses were used to summarize participant characteristics, chi-square tests assessed group differences, and logistic regression models examined predictors of palliative care needs. Results: A total of 611 older adults participated, of whom 6.5% were identified as having palliative care needs. Dependency in activities of daily living (p = 0.024) and poorer self-rated health (p = 0.001) were significantly associated with increased palliative care needs. Participants demonstrated a greater preference for comfort-oriented care for themselves than for family members. Gender differences were observed in care setting preferences: females were more likely to favor palliative care institutions, while males tended to choose non-palliative care wards in general hospitals. Conclusions: Even in Shanghai, where palliative care services are relatively advanced compared with other regions of China, awareness and utilization remain low among older adults with chronic conditions. Functional decline and negative self-rated health are associated with palliative care needs, underscoring the importance of incorporating functional and health assessments into community health services to identify eligible individuals earlier. The observed discrepancy between self- and family-oriented preferences, alongside gendered differences in care setting choices, highlights the need for culturally sensitive communication and tailored service provision. Expanding community-based palliative care and increasing public education may help align services with the needs and preferences of older adults in China.

Background X-linked hypophosphataemia (XLH) is a rare inherited disorder often misdiagnosed and lacking sufficient aetiological treatment. Previous studies have shown that XLH is associated with worse health-related quality of life (HRQoL) and greater economic burden for children and their families compared with the general population, but evidence from China is scarce. This study aimed to comprehensively explore the burden and HRQoL of XLH children in China.Methods An online retrospective survey of paediatric patients with XLH and their caregivers was conducted nationwide during March to June 2021. A self-administered questionnaire was used to collect socio-demographic, clinical and economic data. The EQ-5D-Y-3L instrument was employed to assess HRQoL, and the health utility score was calculated. Direct medical, non-medical and indirect costs were determined. Multivariate regression analysis was performed to explore potential associations between HRQoL and identified influencing factors.Results The study included 221 subjects with a mean age of 7.25 years, of whom 119 (53.8%) were girls. Most XLH children (63.8%) lived in rural areas, and 39.4% reported a family history. Over 70% experienced misdiagnosis. The average total annual cost per patient was found to be 34 657.85 CNY. Of direct medical costs, patients’ out-of-pocket expenses were substantial. The incidence of catastrophic health expenditure was 19.9%. The means (SD) of EQ-5D-Y-3L health utility and EQ-5D VAS scores were 0.83 (0.14) and 56.07 (10.95). Both univariate and multivariate analyses found older age and lower economic affordability were associated with poorer HRQoL.Conclusions The study underscores the significant burden of XLH on paediatric patients and their families in China, both in terms of HRQoL and economic costs. The findings emphasise the importance of early detection, accurate diagnosis, cost-effective targeted interventions and long-term multidisciplinary management strategies to improve the lives of XLH children and their families.

医保监管是医保管理的重点任务,在数据时代,医保大数据的充分应用是推动医保监管能力现代化的有力支撑,也是医保经办管理不可或缺的技术手段.上海市作为国家智能监控示范点,积极探索建立医保安全管理信息平台,应用大数据挖掘新技术建立数据模型,推动数据质量提升及精细化管理水平,有效监管医保基金.本文探讨上海市医保智能监管的建设与发展历程,通过案例分析介绍数据挖掘技术在医保基金监管中的应用,并分享成果与效益以期提供经验与启示.

ObjectiveTo investigate the satisfaction of both service providers and users in community health service centers through questionnaires， and to analyze the reasons， so as to put forward suggestions for improving satisfaction.MethodsSampling was conducted in 247 community health service centers in 16 districts of Shanghai， and data were collected from employees and patients through on-site questionnaires.ResultsA total of 10 334 eligible questionnaires were collected from community health service centers， of which 7 712 were from patients and 2 622 were from employees. In 2021， the public's satisfaction with community health service centers was 96.51 points， and the satisfaction of employees was 94.08 points. The public expressed lower satisfaction with the availability of essential drugs for outpatient services， while the staff were less satisfied with their salary and benefits， work recognition， and career development. Regarding family doctor services， 73.38% of the public had signed up for family doctor services， while 23.57% of the public did not know about the family doctor services， and 16.18% believed it was necessary to improve the publicity of basic public health services.ConclusionThe public's overall satisfaction with the service of community health services is gradually increased. The basic medical services of community health are recognized by residents. Drug allocation needs to be improved urgently， and publicity and promotion need to be further strengthened. The overall satisfaction of employees is high， but further improvement is needed in terms of salary and benefits， work recognition， and career development.

功能社区作为社区卫生服务的拓展和延伸,对于改善功能社区人群卫生服务的可及性、实现社区卫生服务的公平性具有重要意义.本文运用SWOT分析法探讨上海市开展功能社区社区卫生服务的优势、劣势、机会和风险,并提出推进功能社区建设的若干策略.

目的 构建一套符合上海实际的社区健康治理的综合考评指标体系,科学、真实地反映社区卫生服务治理成效与问题.方法 在文献研究的基础上,通过开展两轮德尔菲专家咨询确定最终纳入的评价指标.结果 建立了包含3个维度,8个二级指标,37个三级指标的上海市社区健康治理考评指标体系.专家权威系数为0.91,两轮咨询积极系数均为100％,重要性协调系数分别为0.18、0.28,差异均有统计学意义(P＜0.05).结论 该指标体系可信度高,兼顾治理过程和结果,适用于管理部门开展相关考核评价,助力提升城市社区健康治理水平.

目的:对上海市部分区域的社区卫生服务机构负责人开展问卷调查.方法:于2021年12月采用分层整群抽样方法,在中心城区随机抽取5个区域,在郊区随机抽取3个区域,选取这8个区域的社区卫生服务机构负责人进行问卷调查.结果:113名机构负责人中,61名(54.0％)对职业化发展了解程度一般,62名(54.9％)认为有必要实施领导人职业化,69名(61.1％)认为实施领导人职业化是可行的,愿意成为职业化领导人的有63名(55.8％),阻碍机构负责人职业化发展得分最高的影响因素为"现行机构负责人薪酬制度存在问题".结论:应构建机构负责人职业化制度,不断完善职业化改革的制度基础;完善机构负责人选拔任用,明确职业化机构负责人的准入标准;建立机构负责人职业化的相关激励机制,研究职业化机构负责人的年薪制与监督考核制度.

新冠疫情期间,各地基层医疗卫生机构履职尽责,全力参与疫情防控工作,为有效遏制疫情在城乡社区的扩散和蔓延,发挥了重要的基础性作用.广大基层医疗卫生机构承担了大量社区疫情防控、隔离场所管理、核酸采样、疫苗接种等工作.以上海市为例,2022年12月,社区发热诊疗量占全市发热诊疗量的比例从月初的1％迅速提升到月末的50％以上,有效满足了居民发热就近就诊需求,大大缓解了二三级医院发热诊疗压力.

ObjectiveBased on a demand survey， to put forward the idea of family doctor service health service packages for people in functional communities， and provide suggestions for the implementation of family doctor health service in such communities.MethodsThrough the stratified cluster sampling survey of a science and innovation bearing functional community， combined with literature research， current situation survey， case analysis and interviews， this paper proposes the service content of the service packages.ResultsOn the basis of demand survey， the mode of "specified action + optional action" should be adopted. Community health service center should first provide basic service， and then expand their services in diagnosis， treatment， and health management in line with local demand， and provide optional multi-level health service packages for scientific and innovative functional community residents， which should be divided into basic health service， value-added health service and high-end health service.ConclusionSorting out the content of health service packages of family doctor service in functional communities can provide the basis for further improving the allocation of medical service resources， further optimizing the design of the financing and compensation mechanism， and further standardizing the contract service of family doctors.

目的:了解浙江省杭州市医护人员的肌少症认知、信念和行为现状.方法:于2022年1月采用分层抽样方法选取浙江省杭州市8家社区卫生服务中心、2家公立医疗机构和1家民营医疗机构的医护人员进行问卷调查,共纳入163名.结果:163名医护人员的肌少症相关知识认知率为49.8％,不同职称和在不同时间参加肌少症相关知识培训的医护人员肌少症认知情况差异有统计学意义(P<0.05).医护人员对肌少症信念条目比较赞同和非常赞同的比例之和总体较高,除肌少症在老年人中发病率较高的条目外,其余条目的比较赞同和非常赞同比例之和均超过80.0％.医护人员各项肌少症行为条目中,选择从不或偶尔的占比较高,比例之和均接近或超过50.0％.结论:浙江省杭州市医护人员对肌少症相关知识的认知、信念和行为情况仍有待提升,医护人员应积极参加各类学习,主动在日常工作中开展肌少症评估,增强对肌少症相关知识的早期识别和干预意识,以期改善肌少症知信行现状.

According to project report“Governance for health in the 21 st century”of WHO,this paper reviews and expounds the three waves in the development history of global health governance and the development course of Chinese health governance. It summarizes the enlightenment on China’s health governance under the background of epidemic prevention and control: constructing an integrated health service model with the integration of medical and prevention and the combination of general medicine and specialized medicine; transforming medical treatment to health, building a concept of all-round and full-cycle health service; All policies aim to improve people’s health and well-being. Through optimizing the health governance system, mode and system, realize the modernization of health governance capacity in China.

目的 根据上海市的国家三级公立医院绩效考核非监测指标数据,研究国家三级公立医院绩效考核29项非监测指标的权重系数,为提高三级公立医院绩效评价效果提供借鉴.方法 运用专家咨询法与熵权法分别对29项国家非监测指标进行赋权,最终以主客观赋值结合的方法得到权重系数.结果 两种赋权方法的指标对比,人才培养、学科建设等部分的权重系数存在较大差异.结论 根据上海市的绩效考核数据,通过主客观结合的方法建立国家三级公立医院绩效考核非监测指标权重系数有助于其他省市及其他医院开展相关绩效评价,能够更好地促进公立医院按照国家要求高质量发展.

Background: Quality measurements in primary healthcare (PHC) have become an essential component for improving diabetes outcomes in many high-income countries. However, little is known about their implementation within the Chinese health-system context and how they are perceived by patients, physicians, and policy-makers. We examined stakeholders’ perceptions of quality and performance measurements for primary diabetes care in Shanghai, China, and analyzed facilitators and barriers to implementation. Methods: In-depth interviews with 26 key stakeholders were conducted from 2018 to 2019. Participants were sampled from two hospitals, four community healthcare centers (CHCs), and four institutes involved in regulating CHCs. The Consolidated Framework for Implementation Research (CFIR) guided data analysis. Results: Existing quality measurements were uniformly implemented via a top-down process, with daily monitoring of family doctors’ work and pay-for-performance incentives. Barriers included excluding frontline clinicians from indicator planning, a lack of transparent reporting, and a rigid organizational culture with limited bottom-up feedback. Findings under the CFIR construct "organizational incentives" suggested that current pay-for-performance incentives function as a "double-edged sword," increasing family doctors’ motivation to excel while creating pressures to "game the system" among some physicians. When considering the CFIR construct "reflecting and evaluating," policy-makers perceived the online evaluation application – which provides daily reports on family doctors’ work – to be an essential tool for improving quality; however, this information was not visible to patients. Findings included under the "network and communication" construct showed that specialists support the work of family doctors by providing training and patient consultations in CHCs. Conclusion: The quality of healthcare could be considerably enhanced by involving patients and physicians in decisions on quality measurement. Strengthening hospital–community partnerships can improve the quality of primary care in hospital-centric systems. The case of Shanghai provides compelling policy lessons for other health systems faced with the challenge of improving PHC.

梳理国内外关于区域医疗中心综合评价的文献,从评价对象、理论基础与模型、评价指标、评价方法几个方面进行对比研究,提出从强化区域医疗中心评价的定量模型与理论基础研究、构建动态化、系统化的区域医疗中心评价指标体系、建立区域医疗中心动态追踪调查评价机制等方面完善国内区域医疗中心综合评价体系.

背景 上海市作为国家科技创新中心重要承载区,除了满足创新创业的政策支持、创业环境、资金投入等需求外,满足各类人才在健康保健等方面的延伸需求对于促进"产城融合"至关重要.发展功能社区卫生服务是完善功能配套、促进"产城融合"的关键环节,但当前功能社区服务存在短板,无法为"产城融合"提供支撑,亟须突破.目的 分析科创承载型功能社区人群多样化的健康服务需求,并为家庭医生健康服务在功能社区的拓展提供建议.方法 2019年3—11月,通过对上海市科创承载型功能社区进行分层随机抽样调查,共发放1500份问卷,获得功能社区人群基本情况及生活方式、心理健康状况、卫生服务需求与利用等相关数据,了解功能社区人群的健康状况、卫生服务需求与利用情况,并分析功能社区家庭医生服务需求的影响因素;并参考文献研究结果,对比与其他类型功能社区人群的主要健康问题与卫生服务需求的差异.结果 共回收有效问卷1487份(99.13％),其中调查对象两周患病率〔5.92％(88/1487)〕、慢性病患病率〔5.98％(89/1487)〕较低;功能社区人群健康服务主观需求主要是常见疾病处理(1251人,84.13％)、健康管理(858人,57.70％)、健康体检(699人,47.01％)、健康咨询(586人,39.41％)、心理咨询(470人,31.61％).功能社区人群家庭医生签约服务知晓率为57.03％(848/1487),45.73％(680/1487)有签约意愿,且性别、年龄、文化程度、自我感觉健康状况、慢性病患病情况对家庭医生签约意愿产生影响(P<0.05);就诊意愿调查中,患病后想去的卫生机构前3位分别是市级医院(620人,41.69％)、区级医院(404人,27.17％)、门诊部(所)/卫生室/卫生服务站(153人,10.29％),其中质量(734人,25.41％)、距离(732人,25.34％)和有可信赖的医生(391人,13.48％)是主要影响因素;卫生服务实际利用情况与就诊意愿基本一致.结论 在科创承载型功能社区中开展健康保健服务具现实意义和可操作性.不同类型功能社区卫生服务需求可能存在差异,应针对不同需求提供差异化的健康服务方案,并吸取其他类型功能社区健康服务发展的优秀经验.建议从明确覆盖人群与服务内容、丰富供给方式、优化筹资来源、加强统筹协调等角度完善功能社区家庭医生服务的推进工作.

目的 了解社区医务人员在新冠肺炎疫情期间的社会支持状况以及影响因素.方法 选取上海市社区医务人员340名,采用社会支持评定量表进行调查.结果 社区医务人员社会支持评定量表总得分为(40.67±9.56)分,客观支持维度得分为(9.44±3.85)分,主观支持维度得分为(23.7±5.56)分,对社会支持利用度得分为(7.53±2.16)分.多因素分析结果显示,性别、压力最大的工作与社会支持呈正相关,婚姻状况与社会支持呈负相关.结论 上海市社区医务人员在新冠肺炎疫情期间获得的社会支持总体情况良好,但客观支持来源以及对支持的利用度不足.建议通过不同途径提高社区医务人员的社会支持,从而保障他们的身心健康.

Objective To understand the effect of the health institution combinative contracting mechanism (which make participating residents make a "combinative contracting" involving family doctor of community health center, one secondary hospital, and one tertiary hospital) on community residents' patient experiences in Shanghai, China. Methods We conducted two questionnaire surveys (2016 and 2018) on the patient experiences of 1200 permanent residents of 12 subdistricts of Shanghai, who were selected via stratified random sampling. Of these, 926 participants were included after propensity score matching. We compared five dimensions of patient experience-accessibility, environment and facilities, service attitude and emotional support, communication and patient engagement, and service integration-before and after implementation of the health institution combinative contracting mechanism in June 2016. Furthermore, logistic regression analysis was used to explore the factors related to residents' overall experience. Results The health institution combinative contracting mechanism influenced most dimensions of residents' patient experience, such as accessibility, service attitude and emotional support, communication and patient participation, and service integration. The mechanism in general helped contracted residents obtain a better patient experience than before its implementation. Referral had a significant effect on participants' overall experience. Conclusion Contracted family doctors play active roles in improving nearly every dimension of residents' service experience, as well as their overall experience of services. The health institution combinative contracting mechanism not only increases interaction and strengthens trust between doctors and patients but also makes it possible for residents to obtain integrated health services.