Background Since the full implementation of contracted family doctor services in 2016, we have achieved phased results. Further work needs to be paid equal attention to "quality" and "quantity", focusing on improving the residents' sense of service access and satisfaction, however, at present, the residents' evaluation of contracted family doctor services is not clear. Objective To investigate the contracted residents' evaluation for the continuity of family doctor contract, explore its influencing factors, and propose improvement strategies. Methods This study used a multi-stage stratified random sampling method to select 1 193 contracted residents from 9 community health service institutions and 9 township health centers in Heze City, Shandong Province in January 2021. A household survey was conducted on the included residents by using the continuity dimension of the Chinese version of the Primary Care Assessment Tools (PCAT) , which contains 15 items. We compared the PCAT-continuity dimension scores of contracted residents with different characteristics, and used multiple linear regression to analyze the factors influencing the PCAT-continuity dimension scores of contracted residents. Results A total of 1 098 valid questionnaires were collected, with a valid response rate of 92.04%. 541 (49.27%) of them were contracted to community health service institutions and 557 (50.73%) of them were contracted to township health centers. The average score of the PCAT-continuity dimension of the contracted residents was (3.38±0.51) . The item with the highest score was "Does your family doctor listen to you patiently", with a score of (3.64±0.59) . The item with the lowest score was "Would you be willing to change your family doctor if it was easy to do so", with a score of (2.98±0.92) . Multiple linear regression analysis showed that the type of contract organization, age, education, marital status, occupation, and chronic diseases were the factors that influence the PCAT-continuity dimension score of contracted residents (P<0.05) . Conclusion The contracted residents had an overall good evaluation on the continuity of contracted family doctor services, and the long and stable doctor-patient relationship had been established. Township health centers are better than community health service institutions. To further improve the contracted residents' evaluation of contracted family doctor services, we need to pay more attention to the type of contracting institution, the age, education level, marital status, occupation of contracted residents and their chronic diseases.

Abstract Background: From the perspective of the demander, the purpose of the study is to find out the weak link of the family doctor contracted service in a city, that is, to optimize the effect of the family doctor contracted service in China.Methods: In this study, a city in Shandong Province, China was selected as the sample city. In January 2020, 1098 contracted residents (including 40.5% men and 59.5% women) from 18 primary medical institutions (including township health centers and community health centers) were selected for on-site investigation. The PCAT-AS scale revised in Chinese was used as the research tool to understand the treatment experience of contracted residents in primary medical institutions.Results: Among the four core dimensions of PCAT-AS, the score of Continuous was the highest (3.44 ± 0.58); The score of Coordinated was the lowest (3.08 ± 0.66); Among the three derived dimensions, the score of Family-centeredness was the highest (3.33 ± 0.65); The score of Culturally-competent was the lowest (2.93 ± 0.77). The PCAT scores of contracted residents with different demographic characteristics such as contracted institution, age, education level, marital status and occupation were statistically significant (P < 0.05).Conclusions: The family doctor contracted service in the city has achieved certain results. At the same time, there are still some problems, such as difficult access to outpatient services during nonworking hours and incomplete service items. It is suggested that primary medical institutions further improve their service capacity in the dimensions of Coordinated and Comprehensiveness, in order to provide better services for contracted residents.

背景 基层医疗机构的连续性服务能够有效促进医疗资源合理利用，降低医疗费用，但当前对其研究仍有待加强 目的 评价家庭医生签约服务背景下某市基层医疗机构服务连续性现状，探讨影响因素并提出改进策略。方法 利用汉化版的基本医疗质量评估量表（Primary Care Assessment Tools, PCAT）的连续性维度，于2021年1月对某市9所社区卫生服务中心和9所乡镇卫生院的1193名签约居民进行入户调查，了解基层医疗机构的服务连续性。运用描述性统计、单因素方差分析及多元线性回归进行数据分析。结果 共回收有效问卷1098份，有效回收率为92%。该市基层医疗机构服务连续性得分为3.38分。签约机构、年龄、教育程度、婚姻状况、职业、是否确诊慢性病是基层医疗机构服务连续性得分的影响因素。结论 该市基层医疗机构服务连续性总体较好，但仍有提升空间，建议进一步强化基层医疗机构人才队伍建设、加强医患沟通、引导居民形成“基层首诊”观念、开发利用移动端预约和咨询平台、合理扩大家庭医生签约服务规模，以期为居民提供长期、连续、稳定的基本医疗服务。

Objective:To explore the current status of medical preventive integration at primary medical institutions, analyze the problems of medical prevention integration, and put forward optimization suggestions.Methods:From June to July 2020, 169 primary medical institutions in a city were selected as the survey objects to conduct a questionnaire survey on the basic information of institutions and the evaluation indicators of medical preventive integration. The evaluation index system of medical preventive integration was divided into a factual survey and a sensory survey. In addition, 32 relevant personnel were interviewed on the current situation of medical preventive integration at primary medical institutions. The reliability and validity of the data were tested and analyzed, while descriptive analysis and classification extraction analysis were carried out.Results:The reliability and validity analysis proved the data reliability. The factual survey extracted three common factors, namely organization management, performance appraisal distribution and information management. The sensory survey extracted two common factors, namely working mode and personnel training. In terms of organization, management and working methods, the degree of medical preventive integration was low. Among them, 53.8% of the institutions had formulated the medical preventive integration norms, and only 41.4% of them had shared residents′ health information in time.Conclusions:The degree of medical preventive integration of primary medical institutions in the city still need to be improved. In the future, we should strengthen the top-level design, establish the norms and cooperation mechanism of medical preventive integration, improve the awareness of medical preventive integration of medical personnel, improve the information level, and to build a new service model integrating disease prevention, medical treatment and health management.

Objective:To evaluate and analyze the patient experience of residents contracted with primary medical institutions, for providing a basis for improving quality of contracted family doctor services.Methods:Using the Chinese version of the primary care assessment tools(PCAT), a household survey was conducted on 1 400 contracted residents in 9 community health service centers and 9 township health centers in a city from May to June 2020, and their medical experience in primary medical institutions was statistically analyzed. At the same time, interviews were conducted with institutional managers and family doctors. Descriptive statistics and one-way ANOVA were used for data analysis.Results:1 333 valid questionnaires were collected, and the effective recovery rate was 95.2%.The total PCAT scoring was 25.17. Seven dimensions of first contact, continuous, coordination, comprehensiveness, patient and family centered, community-oriented and cultural competence scored in average 3.57, 3.68, 3.54, 3.40, 3.72, 3.67 and 3.59 respectively.372 people(47.1%) had not been referred by the contracted institution before going to the superior hospital or specialized hospital. There were significant differences in the scores of four core dimensions in different types of institutions, age, education level, occupation and income( P<0.001). Conclusions:Given the initial progress of contracted family doctor services in the city, there is still room for improvement. It is suggested to further improve the comprehensiveness, coordinationand accessibility of services, and promote the high-quality development of contracted family doctor services.

Objective:To analyze the cognition and willingness of family physicians on contracted service, and to explore the implementation obstacles and feasible strategies of implementing contracted service of family physicians from the perspective of suppliers.Methods:From July to October 2020, 850 family physicians in community health service centers or township health centers in three cities of Shandong Province were investigated by questionnaire survey and key person interview. Descriptive analysis and binary logistic regression model were used to analyze the willingness of family physicians to provide contracted service. Through questionnaire survey and key person interview, the implementation obstacles and service optimization strategies of family physicians were discussed.Results:791 valid questionnaires were obtained, of which 688(87.0%) approved the implementation of family physician contract service, and 679(85.8%) expressed willingness to provide family physician contract service. Marital status, recognition of service policy, satisfaction of service operation effect, optimistic degree of service development prospect and residents′ first choice of illness were the factors influencing family physician′s service willingness.Conclusions:We should effectively improve the family doctor′s service intention and promote the efficient and orderly implementation of family doctor′s contract service policy through enriching policy supporting measures, innovating the application of " Internet plus" , increasing personnel training, optimizing performance appraisal work and creating favorable public opinion environment.

Objective:To understand the willingness of contracted residents to renew the family doctor contract service in Shandong Province, and to explore its influencing factors.Methods:From July to August 2020, 1 500 contracted residents in 3cities of Shandong Province were investigated by questionnaire survey.Descriptive statistical analysis, Mann-Whitney U test and binary logistic regression model were used to analyze the contracted residents′ cognition, utilization, satisfaction evaluation and renewal intention of family doctor contract service. Results:1 445 valid questionnaires were obtained, of which 682(47.2%)were willing to renew their contracts.The results of binary logistic regression analysis showed that marital status, educational level, time to see a doctor in contracted institutions, optimism about the development prospect of contracted service policy, whether the proportion of medical insurance reimbursement increased after signing the contract, whether follow-up work was carried out on time, satisfaction with family doctor service attitude and satisfaction with the effect of disease treatment were factors affecting the willingness of contracted residents to renew the contract.Conclusions:The contracted residents in Shandong Province have a high willingness to renew their contracts. On the basis of consolidating and improving the policy cognition and confidence of the contracted residents, we should actively optimize and improve the contracted service quality, ensure the sense of service access of contracted residents, and continuously and effectively realize the comprehensive promotion of the contracted services of family doctors.

Object: By combing the policy content of the standardized resident training system in China, this paper analyzes the residents’ cognition and satisfaction evaluation of standardized training policy, and discusses the implementation obstacles and feasible strategies of the Chinese standardized resident training. Method Using policy text analysis to sort out the policy content of the Chinese standardized resident training system; A questionnaire survey was conducted among 1048 residents in 5 standardized training bases for residents in Shandong Province, China, and a qualitative interview was conducted with 42 residents by personal in-depth interview. Descriptive analysis and binary logistic regression model were used to statistically analyze the residents’ cognition of the training policy, the way of participating in the training, the harvest during the training, existing problems, satisfaction evaluation, and to explore the implementation obstacle factors and optimization strategies of the standardized resident training policy in China. Result Through quantitative investigation and qualitative interview, it is found that the standardized resident training has improved the students’ clinical theoretical knowledge level, practical ability, and doctor-patient communication ability. However, there are still some problems in the standardized resident training in China, such as unreasonable time arrangement, low salary and living security level of residents, weak awareness of teaching, inadequate implementation of training content and assessment, etc. Conclusion The implementation of the standardized resident training system in China has played an important role in cultivating homogeneous and qualified doctors and improving the ability and level of doctors. However, the survey found that the training arrangement is unreasonable, the salary and living security level is not high, and put forward that the training time should be arranged reasonably, the salary and treatment level should be improved, and the awareness of teachers’ responsibility should be improved Strengthen the implementation of training content and assessment. This paper can provide a reference for graduate medical education and the training of human resources in healthcare in other countries and regions.

Objective:To investigate the cognition and willingness of nursing staff to Internet plus nursing service, and analyze the related factors that affect their participation in Internet plus nursing service.Methods:From April to May 2019, 150 nurses from three hospitals in Weifang were investigated by questionnaire and key person interview. Descriptive analysis and binary logistic regression analysis were used to analyze the intention of nursing staff to participate in Internet plus nursing service. The interview mode was used to analyze the appropriate mode of Internet plus nursing service from the perspective of nursing staff.Results:142 valid questionnaires were obtained, of which 137(96.5%)indicated willingness to provide Internet plus nursing services, and 135(95.1%) realized the necessity of the service. Education, marriage, nurses′judgment on the necessity of the service and their own subjective judgment of their competence were the factors affecting nurses′ participation in the Internet plus nursing service.Conclusions:Multiple factors affect the choice of nursing staff′s behavior in Internet plus nursing service.From the perspective of nursing staff, the Internet plus nursing service mode needs joint efforts from many aspects.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:分析评价家庭医生签约服务在政策执行过程中的障碍因素,为推进我国家庭医生签约服务政策的有效运行提供理论依据与决策参考。方法:运用文献分析、卫生统计年鉴、个人深入访谈等方式收集资料,基于霍恩—米特模型分析框架,探讨家庭医生签约服务政策执行中的障碍因素。结果:政策执行障碍因素包括政策标准制定较宽泛、目标可行性较低、政策资源不足（人才资源缺口大、财政资源投入与信息化技术应用不足、权威资源配套机制不健全）、执行方式单一、执行者之间、执行者与目标群体之间缺乏沟通与协调、执行机构间权责分工不明、执行人员的价值取向特性及系统环境复杂多变等问题,一定程度上偏离政策预期效果,使家庭医生签约服务的开展陷入困境。结论:家庭医生签约政策执行中涉及到的霍恩—米特模型的六个变量交互影响,各部门主体应在执行过程中处理好变量间的关系,及时修正、完善存在的问题,保证签约服务政策的长效实施与有序推进。</span>