Professional competence is defined as the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily clinical practice. At present, many studies focus on the application of professional competence to medical education and job evaluation in China. However, further theoretical and empirical research is still needed to facilitate Chinese medical education and physician career development in the future. This article reviews the assessment methods and dimensions of professional competence, as well as the research progress of professional competence in China, with the aim of providing reference for Chinese medical education and physician career development.

Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.

Objective:To analyze the characteristics, keyword clustering and topics of 300 excellent papers in the field of medical education in China from 2017 to 2019, so as to provide suggestions for the development of medical education research.Methods:From August to October in 2021, bibliometric analysis of 300 excellent papers was implemented to construe funding , language, publishing journal and institutions and keywords were clustered.Results:Among the 300 excellent papers, 63.0 % (189/300) papers were supported by the research fund, English papers accounted for 9.0% (27/300). Chinese Journal of Medical Education published the most papers [27.0%(81/300)] . The largest number of papers were published by Peking University Health Science Center [13.7% (41/300)] and Clinical medicine related departments published over thirty percent of the papers [37.7%(113/300)] . Keywords were clustered into 5 topics including education system, teaching method, evaluation, medical students/doctors and development of teachers.Conclusions:The number of papers supported by the research fund and the papers published in English need to be increased; the journals that published these papers were convergent. The universities and their clinical medicine departments play an important role in medical education research. Medical education research is gradually moving towards micro and fine direction. Researchers of medical education can focus on digital teaching form, assessment and evaluation system, ability cultivation of medical students and doctors around the six core competencies that residents should have as well as occupational development of faculty so as to continuously promote the development of medical education research in China.

The soda industry, led by Coca-Cola and PepsiCo, has been playing an essential role in the economy and life of modern society for decades, but the emergence of data analytics applications in recent years has changed and improved all aspects of this industry. This paper starts by discussing the value creation of the soda industry based on the value chain. It then analyzes the role of different popular analytics applications in the various activities of the industry by using several real examples. Further, based on the current industry situation and challenges, this paper predicts the future development trend of analytics applications in the industry.

目的 探究实现我国医院医保精细化管理的不同路径.方法 采用模糊集定性比较分析方法(fsQCA)对34家医院医保精细化管理案例进行组态分析.结果 路径一:组织建设+制度建设+创新模式建设(边缘条件);路径二:制度建设+创新模式建设;路径三:组织建设+信息化建设;路径四:信息化建设+创新模式建设.结论 我国医院医保精细化管理实现路径可分为传统驱动型、创新技术驱动型和综合驱动型3种模式.医院可多元性选择,进一步探索医保精细化管理的现实路径.

目的 基于CiteSpace知识图谱对国内外非计划再手术研究主体、热点进行可视化分析.方法 以PubMed和中国知网数据库中2000—2020年非计划再手术文献为研究对象,运用CiteSpace 5.7软件对非计划再手术文献进行关键词共现分析、突现词分析、发文作者和研究机构分析.结果 共检索到有效的非计划再手术中文文献205篇,英文文献476篇.中文文献作者以三大研究团体为主,研究机构以医院为主;英文文献作者以两大研究团体为主,研究机构以高校和医院为主.中文和英文文献关键词共现分析分别得到5大聚类群,中文文献分别为原因分析、PDCA循环、产后出血、手术并发症和临床分析,英文文献分别为morbidity、fusion、administrative data、NSQIP、laparoscopy.中文和英文文献分别得到7个突现词,中文文献分别为手术并发症、腹部损伤、预防、分析、负性事件、再次手术、影响因素,英文文献分别为adverse event、management、quality、cardiac surgery、NSQIP、pediatric、surgical site infection.结论 相比于国外,国内非计划再手术研究作者和机构更为分散,合作更少,缺少跨区域研究.国内外非计划再手术研究热点主要从临床视角出发,管理学视角和经济学视角研究较少;研究前沿主要为从科室、手术原因角度对非计划再手术进行深入探讨.

目的 基于疾病诊断相关组(DRG)比较分析医院感染患者的经济负担情况,为医院感染防控提供支持.方法 采用回顾性分析方法分析某院2018—2020年住院患者医院感染病例的住院日数及医疗费用,并与DRG同组患者的住院日数及费用等进行比较.结果 2018—2020年医院感染病例数分别为694、1102、819例次,同期DRG分组病例数分别为72707、92837、59398例次;各年份医院感染患者的平均住院日均高于DRG同组患者(31.07 d VS 13.05 d,65.98 d VS 47.51 d,35.38 d VS 13.45 d),差异均有统计学意义(均P<0.01);各年份医院感染患者的平均住院费用均高于DRG同组患者(12.29万元VS 3.84万元,17.18万元VS 4.12万元,15.75万元VS 4.43万元),差异均有统计学意义(均P<0.01).从感染部位来看,导管相关血流感染的平均住院费用最高,2018—2020年各年份分别为22.57、35.88、26.80万元.导管相关血流感染患者的三年平均住院日数为102.00 d、住院费用为28.42万元,较之DRG同组患者的平均住院日数及费用分别增加88.78 d、24.27万元.结论 住院患者发生医院感染将显著增加患者的直接经济负担,控制导管相关血流感染是减轻医院感染经济负担的重中之重,在DRG支付方式下,做好医院感染预防与控制势在必行.

Objective The aim of this study is to establish a hospital-based prevention and control system of respiratory-borne diseases for seasonal influenza and to verify the effect. Methods Influenza cases reported by Peking Union Medical College Hospital in the three flu seasons from November 2017 to February 2020 were retrospectively analyzed. According to the location of occurrence, the influenza cases are divided into hospital influenza cases and non-hospital influenza cases. The incidence of influenza cases in hospital before and after the implementation of the prevention and control system of respiratory diseases were compared. Results A total of 5427 influenza cases that met the inclusion and exclusion criteria were selected for this study. Among them, there were 335 cases (6.17%, 335/5427) of hospital influenza and 5092 cases (93.83%, 5092/5427) of non-hospital influenza. There were 1594 (29.37%, 1594/5427) influenza cases in the 2017-2018 influenza season, 2579 (47.52%, 2579/5427) cases in the 2018-2019 influenza season, and 1,254 (23.11%, 1254/5427) cases in the 2019-2020 influenza season.The incidence of hospital influenza of the 2019-2020 influenza season (3.51%) is much lower than those of the 2017-2018 influenza season (7.59%) and 2018-2019 influenza season (6.59%) (P 0.05). Compared with the 2017-2018 influenza season and 2018-2019 influenza season, the relative risk (RR) of hospital influenza cases in the 2019-2020 influenza season is 0.53 (95%CI:0.39-0.74) and 0.46 (95%CI:0.33-0.65) respectively. Conclusions Hospital-based prevention and control system of seasonal influenza may effectively prevent influenza cases from appearing in hospital.

BACKGROUND:There are disparities of in-hospital non-clinical nursing care delivered by the nursing assistant under different management models in China. This study aimed to identify the best management model of the nursing assistant from the patient perspective.METHODS:This is a cross-sectional study. The inpatient satisfaction with in-hospital non-clinical nursing care delivered by the nursing assistant under different management models was measured and analyzed based on a national inpatient survey Likert the 5-point scale questionnaire conducted in 144 public tertiary hospitals across 31 provinces of China. The study conducted univariate analysis and binary Logistic regression analysis to examine which management model of the nursing assistant and any other key determinants would lead to a positive satisfaction rating by the inpatient who experienced non-clinical nursing care.FINDINGS:The overall satisfaction rating of 6211 inpatients received non-clinical nursing care was 4.73 out of 5, among which 96.09% of the responded inpatients had a positive satisfaction rating. By controlling of the other variables, the likelihood of having a positive inpatient satisfaction rating of non-clinical nursing care delivered by the nursing assistant under the direct commercial company management model, the self-employed model, the commercial company and hospital joint management model accounted for only 14.8%, 20.3% and 35.7% of the nursing assistant under the direct hospital management model.CONCLUSIONS:The direct hospital management model of the nursing assistant might be the best one to deliver the non-clinical nursing care that mostly satisfied the inpatient of Chinese public hospitals.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的了解中国三级公立医院接受护工服务住院患者的满意度及其影响因素,为优化我国医院护工管理,更好地满足社会需求提供参考。方法采用随机抽样方法于2019年3月18—31日在中国31个省（自治区、直辖市）和新疆生产建设兵团的144家三级公立医院抽取调查当日及次日出院的23 767例住院患者进行问卷调查,分析其中6 211例接受护工服务住院患者的护工服务满意度;采用分层随机抽样方法在东、中、西部地区样本医院中各随机抽取2～3家医院,利用滚雪球抽样方法进一步抽取50例接受过护工服务的住院患者,采用一对一半结构化访谈提纲就患者对护工服务满意度的影响因素进行深入访谈,并采用扎根理论分析方法对访谈结果进行分析。结果 6 211例接受护工服务的住院患者中,5 968例对护工服务满意,对护工服务的满意率为96.09%。扎根理论分析结果显示,影响住院患者对护工服务满意度的重要因素有与护工个体特点有关的护工素质、态度和价值,与医院和护工管理公司相关的护工来源和护工管理以及与社会环境相关的市场体系和护工地位等;其中,护工个体为医院和护工公司以及护工市场提供了人员基础,医院和护工公司为护工服务提供了直接保障,社会为护工服务提供了间接保障,三者相辅相成,互相影响,共同影响着护工服务的质量和患者对护工服务的满意度情况。结论中国三级公立医院接受护工服务住院患者满意度有待提高;护工个体、医院和护工管理公司以及社会环境互相作用,共同影响着住院患者对护工服务的满意度。</span>

Objective To study patient satisfaction at tertiary hospitals in China, and explore the influence of such factors as sociodemographic and institutional characteristics on the their satisfaction. Methods Based on the third round third party evaluation of China Healthcare Improvement Initiative(the Initiative), a patient satisfaction survey was made from December 2017 to January 2018 at 136 public tertiary hospitals across the country.Chi-square test and binary multivariate logistic regression methods were used to identify influencing factors for patient satisfaction. Results Patient satisfaction varies significantly among hospitals of different types, regions and institution affiliations.Satisfaction of outpatients at their local hospitals was 1.395 times higher than those hospitals under the National Health Commission, and that of inpatients at the central regions was 1.352 times higher than those of the eastern region.Gender, department, education level, medical insurance, patient source and registration method were significant influencing factors for overall satisfaction of outpatients(P<0.05); Region, department and occupation were significant influencing factors of overall satisfaction of inpatients(P<0.05). Conclusions The allocation of medical resources should consider hospital type and region.The affordability of medical expenses and fairness of medical insurance system deserve more attention.The satisfaction of women and children patients should be improved by providing high-quality and humane medical and nursing care. Key words: Patient satisfaction; Outpatients; Inpatients; Influencing factors; Third party evaluation

Study on the influencing factors for patient satisfaction at tertiary hospitals in China [Abstract] Objective To study patient satisfaction at tertiary hospitals in China, and explore the influence of such factors as sociodemographic and institutional characteristics on the their satisfaction. Methods Based on the third round third party evaluation of China Healthcare Improvement Initiative( the Initiative), a patient satisfaction survey was made from December 2017 to January 2018 at 136 public tertiary hospitals across the country.Chi-square test and binary multivariate logistic regression methods were used to identify influencing factors for patient satisfaction.Results Patient satisfaction varies significantly among hospitals of different types, regions and institution affiliations.Satisfaction of outpatients at their local hospitals was 1.395 times higher than those hospitals under the National Health Commission, and that of inpatients at the central regions was 1.352 times higher than those of the eastern region. Gender, department, education level, medical insurance, patient source and registration method were significant influencing factors for overall satisfaction of outpatients ( P <0.05 ); Region, department and occupation were significant influencing factors of overall satisfaction of inpatients ( P < 0.05 ). Conclusions The allocation of medical resources should consider hospital type and region.The affordability of medical expenses and fairness of medical insurance system deserve more attention. The satisfaction of women and children patients should be improved by providing high-quality and humane medical and nursing care.

目的 了解四川省泸州市居民对健康城市建设的满意度与主观幸福感的关系,为我国健康城市建设提供科学依据.方法 采用多阶段抽样的方法抽取了7964名居民,通过问卷调查了解其对健康城市建设的满意度和主观幸福感,利用多水平Logistic回归模型分析居民对健康城市建设满意度与主观幸福感的关系.结果 居民对健康城市建设医疗卫生服务、医疗保障体系、自然环境、健康知识宣传、社会治安、社会保障体系、食品安全和健身娱乐活动的满意率分别为:78.07％(95％ CI:77.13％～78.99％),75.74％ (95％ CI:74.77％～76.69％),75.05％ (95％ CI:74.08％ ～76.02％),74.77％ (95％CI:73.79％ ～75.74％),74.60％ (95％CI:73.61％～75.56％),71.22％ (95％ CI:70.20％～72.23％),65.51％ (95％ CI:64.44％～66.57％)和58.88％(95％CI:57.78％ ～59.98％),其中居民对食品安全和健身娱乐活动的满意率较其他维度低,P＜0.05.调整混杂因素后,居民对社会保障体系(OR=1.63,95％CI:1.34～1.98)、健身娱乐活动(OR =1.49,95％ CI:1.28～1.74)和食品安全(OR=1.49,95％ CI:1.25 ～ 1.76)的满意度与主观幸福感之间存在正向关联.结论 四川省泸州市居民对健康城市建设的满意率较高,其对健康城市建设的满意度与主观幸福感正向相关.

目的 了解四川省泸州市健康城市建设对居民健康素养影响情况,为政府主导健康城市建设提供科学依据.方法 采取按人口比例分层随机抽样方法,对泸州市居民进行“健康城市建设效果居民评估调查”及居民健康素养调查,将基线期与中期进行比较,分析健康城市建设成效及对居民健康素养促进的作用.结果 泸州市健康城市项目实施3年后,城乡居民对泸州市健康城市建设的总体满意度为77.1％;居民综合健康素养具备率由9.21％增长至12.3％,农村居民健康素养水平增幅(93.8％)显著,城乡差距减小;居民卫生行为有明显改善;居民体力活动达标率由52.6％提高至57.40％,公共场所吸烟现象得到改善;多元回归分析显示,对健康城市建设服务满意者具备基本健康素养的可能性增加1.5 ～3.5倍.结论 以“政府主导、各部门协调、社会参与”的健康城市建设模式对提高城乡居民的综合健康素养、改善卫生环境和习惯具有促进作用.

目的 基于interRAI家庭照护评估工具(interRAI-HC)了解居家老年人抑郁风险并探讨其影响因素.方法 采用方便抽样法对153例≥60岁的居家老年人进行入户调查,由培训合格的评估员依据interRAI-HC进行评估,通过ChinaRAI软件计算抑郁风险得分并生成触发问题,Logistic回归分析探讨抑郁影响因素.结果 46.4％居家老年人存在抑郁风险;嗜睡、疼痛、尿失禁为抑郁发生的风险因素(均P＜0.05).结论 居家老年人抑郁风险有一定的普遍性,以嗜睡、疼痛、尿失禁者尤甚,应采取针对性干预措施.