毕业生质量调查是高校评价教学质量的重要环节,也是制定完善人才培养方案的重要参考.通过向杭州医学院2012～2021届农村社区医生定向培养(3年制)毕业生及用人单位发放调查问卷的形式,进行毕业生质量跟踪调查.通过分析调查结果,总结了我校在农村社区医生定向培养方面的经验,为进一步探索如何加强和改进培养适应社会需求的农村社区卫生人才提出建议.

Objective:To establish a set of scientific and reasonable indicator system of common prosperity in the field of health, so as to promote the construction and evaluation of the demonstration area of common prosperity with high quality of health.Methods:According to the requirements of promoting common prosperity demonstration area with high quality of health in Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis in July 2021, and experts were convened to carry out expert brainstorming to determine indicator system in the form of meetings. Delphi method was used to conduct two rounds of expert consultation on the indicator system.Finally, the analytic hierarchy process and percentage weight method were used to calculate the indicator weight value.Results:The final indicator system included 4 first-level indicators and 30 second-level indicators. Among the first-level indicators, the weight values of the development, equilibrium, inclusiveness, and sustainability were 0.326 4, 0.242 8, 0.245 8, and 0.185 0. There were 8 second-level indicators in developmental indicator dimension, of which the indicator with the highest weight was the per capita health expectancy. The balance indicator dimension included 6 second-level indicators, of which the indicator with the highest weight was the per capita financing difference of basic medical insurance between the urban workers with the urban-rural residents. The inclusive indicator dimension included 6 second-level indicators, and the proportion of personal health expenditure to total health expenditure had the highest weight. The sustainability indicator dimension included 10 second-level indicators, and the proportion of government health expenditure in fiscal expenditure had the highest weight.Conclusions:The indicator system constructed in this research could provide certain guidance and reference for promoting the construction of common prosperity in health, and provide some reference for follow-up research in this field.

Objective:To establish a set of evaluation indicator system of policy coordination of integrated county healthcare consortium based on the construction practice of integrated county healthcare consortium in Zhejiang province.Methods:Based on the guiding opinions and relevant supporting policy documents issued by Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis, and the indicator system was modified and perfected in two rounds by Delphi method. The weight value of the indicators was calculated by the priority chart method.Results:The indicator system included 4 first-level indicators, 10 second-level indicators and 35 third-level indicators. Among the first-level indicators, the weight values of health insurance payment, personnel salary, price reform, fiscal and finance were 0.406, 0.281, 0.141 and 0.172, respectively.Conclusions:The indicator system established in this study has certain rationality and feasibility, which can provide reference for promoting the construction of integrated county healthcare consortium in China from the perspective of policy coordination, and provide reference for relevant scholars to carry out follow-up research.

目的 通过描述性统计对嵊州市按人头付费与签约服务相结合试点改革的效果进行初步评估,为后续的改革推进提供指导和建议.方法 采用Excel2016对所有数据进行整理,对按人头付费改革的医院业务数据和医保基金运行情况进行表述性统计分析.结果 改革后,门急诊和住院业务数量增长显著,平均住院日延长.门急诊和住院收入均增加,但住院收入增加更为显著,但住院药品收入控制比门急诊药品收入控制效果更好.门诊和住院的年人次均费用的增长率为负增长,初步实现均次费用控费目标.居民医保支付总费用改革前为1167.77万元,改革后为1366.35万元,实际增长率为11.44％,医保支付费用仍在增长.医保基金结余改革前后均处于赤字状态,但改革后有所改善.结论 按人头付费效果初步显现,基本实现门急诊和住院次均费用控费目标,但医保基金仍处于赤字,仍需要改革的持续推进,逐步实现结余目标.

基本公共卫生服务是深化医药卫生体制改革和实施"健康中国"战略的重要内容.县域医共体是重塑我国县乡村三级医疗卫生服务体系的重要创新举措,涉及法人治理、人事薪酬、医保支付、财政保障等体制机制改革.县域医共体在落实基本公共卫生服务任务的过程中可能存在以下几方面需要解决的问题:牵头医院基本公共卫生服务职能分散;医防深度融合新模式亟待完善;经费使用管理的规范性有待考验;绩效考核中的多元主体关系不明确.为完善基本公共卫生服务供给机制应优化医共体公共卫生机构设置,健全专业公共卫生机构融入医共体的工作机制;整合公共卫生和医疗服务资源与流程,形成医防协同一体化服务模式;强化公共卫生评价考核,推动从按人均标准补助模式向按绩效购买服务模式转变.

目的 调查医共体背景下浙江省居民对政策认知及获得感情况.方法 采用多阶段分层随机抽样方法,于2019年7月在实施医共体改革的县(市、区)抽取550名居民,使用自行设计问卷开展调查.结果 仅7.6％调查对象表示比较了解医共体政策,51.4％表示没有听说过,36.4％居民听说过有上级医院专家定期下派到基层;对于是否接受过上级医院下派专家诊疗、是否在基层预约到上级医院专家号以及是否在基层预约到上级医院的检查化验,比例均在10％左右;但有54.1％遇到在基层配不到药的情况和51.4％遇到检查得不到上级医院认可的情况;调查结果显示就诊选择基层机构的比例为40.1％.结论 应进一步加大政策宣传力度,切实落实城市医院专家下基层政策,完善基层药物配备,以信息化促进检验化验结果互联互通.

The past ten years have witnessed China′s primary public health services making remarkable progress in the number of projects and funding subsidy standards, but such problems as the single nature of the main supplying entities, poor supply mechanism and low supply efficiency are still prominent. The authors comprehensively expounded the present situation of the supply of primary public health services in China from the aspects of implementation subject, service content, fund guarantee, human resources, supply mode and performance evaluation, studied and summarized the evolution process and characteristics of public health service supply model. On such basis, they recommended on improving the supply model from the perspective of tripartite subjects of government, market and social organization, so as to speed up the formation of the government-led public service supply model, in which the market, the society and other pluralistic subjects participate equally, construct the competitive supply pattern of medical and health services at county and township levels, strengthen the purchase from social organizations and improve the performance evaluation system and supervision mechanism.

目的 构建县域医疗卫生服务共同体(县域医共体)公共卫生工作绩效评价指标体系,为评价县域医共体公共卫生工作绩效提供依据.方法 根据《2019年度浙江省公共卫生工作任务书(县域医共体版)》及县域医共体公共卫生工作现状制订指标体系框架;邀请高等医学院校、疾病预防控制中心和县域医共体的专家20人,采用2轮专家咨询构建指标体系,并采用层次分析法确定指标权重.结果 专家年龄为(46.10±6.41)岁,工作年限为(23.85±7.37)年,均为本科及以上学历,18位专家具有副高级及以上专业技术职称.2轮专家咨询表回收率均为100.00％;专家权威系数为0.811;肯德尔和谐系数(W)均有统计学意义(P＜0.05),且第二轮咨询的W值均大于第一轮咨询.最终构建了包含10个一级指标,32个二级指标和120个三级指标的县域医共体公共卫生工作绩效评价指标体系;一级指标“重点疾病监测管理”权重最大,为0.165 7;二级指标权重前三位依次是“食源性疾病监测”“传染病与突发公共卫生事件报告”“传染病与突发公共卫生事件处置”,分别为0.071 5、0.064 7和0.063 8;三级指标权重前三位依次是“食品安全事故报告及时率”“传染病报告率”“传染病疫情与突发公共卫生事件及相关信息处置率”,分别为0.039 4、0.022 1和0.021 7.结论 本次德尔菲法构建的县域医共体公共卫生工作绩效评价指标体系可为卫生行政部门开展评价考核提供参考.

目的:调查浙江省社区康复现状,为我省社区康复的可持续发展战略提供依据.方法:选择全省11个地区64家社区卫生服务中心及农村乡镇卫生服务中心发放问卷,对社区康复服务部门人力资源状况 、开展的主要康复治疗项目 、康复站规模及设施等方面进行调查.结果:64家社区共回收有效问卷64份,从调查结果我们可以发现研究生 、本科生 、大专 、中专生分别占5.3％ 、23.0％ 、41.1％ 、30.6％.康复工作人员中康复医师 、康复治疗师 、全科医师 、康复护士分别占25.9％ 、38.5％ 、10.5％ 、27.1％.职称以高级 、中级 、初级分别占5.3％ 、34.3％ 、38.7％.以康复为全职的占36.2％,曾参加康复专科继续教育学习占43.2％.康复治疗(训练)方面主要以上下肢运动能力训练 、推拿按摩为主;针对 ≥65周岁老年人生活及运动方式指导,包括预防跌倒训练 、提高老年人心肺(有氧)能力的训练 、改善老年肌少症的训练等3个项目所占比例均偏低,分别为20.3％ 、18.7％ 、23.4％.社区卫生机构拥有较多的康复硬件是电针仪 、远红外治疗仪 、轮椅 、颈腰牵引床,分别为81.2％ 、76.5％ 、73.4％ 、60.9％.踝关节矫形器 、木丁板 、PT凳 、矫姿镜拥有率最低,分别是29.6％ 、29.6％ 、31.2％ 、32.8％.结论:社区康复在我省得到健康的发展,体系也逐渐完善,但目前仍面临着许多挑战.建议今后我省社区康复服务能力建设过程中将转变社区康复从业人员的服务理念及社区居民的康复意识作为努力方向,重点提高社区康复服务体系中针对老年人及慢病患者的相应服务能力;此外,政策进一步向社区康复倾斜,争取从技术上,资源配备上 、人才管理以及中远期规划上保证和提高社区康复应有的质和量,为我省社区康复事业提供一条可持续发展道路.

本文回顾了中美合作卫生信息管理专业专科层次教育项目的建设与管理过程,分析了生源质量、学生出国意愿、外籍教师选拔及派遣、教育教学质量监督与评估等方面存在的问题,对于高等专科医学类中外合作办学、外籍教师规范管理、保证并提升中外合作高等教育项目的教学质量提出了建设性意见建议.

Today the survival, protection and development of children is a prioritized global issue, of which the survival rate is of primary significance. The key to improve the health condition in children lies in the promotion of equity. China is in a period of social transition, and its inequality is highly prominent in all aspects of the society, especially in the field of public health. The socio-economic status reflects inequality between different social groups, and has become a heated topic in the research of public health. Most studies have been focusing on adults as the object. However, the survival rate of children is the most significant contributing factor to the average life expectancy of the population. This study applies questionnaire surveys to collect data from a large numbers of samples, and explains the impact of socio-economic status on the survival rate in children from an empirical standpoint. Furthermore, it puts forward some suggestions in policy-making to improve the survival rate in children. This study has compensated for the lack of research data in this area in China and abroad, and provides a new perspective in the research of children's health. Samples include the cases of death in children in 30 counties (cities, districts) in Zhejiang Province during the year 2012 to 2014. Self-designed questionnaire of "Surveys on death cases in children under the age of 5" was handed out to first-line workers in monitoring. Once a case of childhood death under the age of 5 occurred, the parents or guardians were called immediately to fill in the retrospective questionnaire. The logistic regression model was used to analyze the impact of socio-economic status on the mortality of children, parameters include the venue of death, treatment received before death, and the stratification of diagnosis made. A total of 3 498 valid questionnaires were recalled, with an effective rate of 99.15％. From the venue of death, 52.2％ died in the hospital, 14.2％ died during transportation to the hospital, and 33.6％ died at home. From the treatment received, 55.2％ were hospitalized, 27.2％ were outpatients, and 17.6％ received no treatment. In the stratification of diagnosis of death, 45.2％ cases were diagnosed in provincial and municipal hospitals, 44. 8％ were diagnosed in the county hospitals, 4.9％ were diagnosed in clinics from lower levels, and 5. 1％ did not visit any hospitals or clinics. Based on the socio-economic status stratification standards,the upper level accounted for 9. 4％ of the death cases,the upper middle level accounted for 16. 4％, the middle level accounted for 41. 3％, the lower middle level accounted for 23％, and the lower level accounted for 9.9％. Logistic regression model showed that with higher socio-economic status of the family, there was a higher probability for the children's death to take place in the hospital, with the difference of 2. 193 times in the upper-level families compared with the lower-level. There was also positive association between the socio-economic status of the family and the rate to be admitted to the hospital before death, with the difference of 2. 904 times in the upper-level compared with the lower-level families. This is also the case in the stratification of the hospital level,the number of cases diagnosed in provincial and municipal hospitals from the upper-level was 3.233 times higher than the lower-level families. Familial socio-economic status affects children's survival rate through influencing prenatal health care,health environment and social resources of their families. Meanwhile, the level of child survival is also affected by whether the children were from urban or rural area and their household registration. Policymakers should focus on children with low socio-economic status by increasing health investment, establishing advanced social support systems and promoting the policies that would benefit for these children. Furthermore, investment on maternal and child healthcare should be increased and the maternal and child health resources need to be allocated in a scientific way to improve the health level of children.

以浙江某医学院校临床专业和非临床相关专业共680名在校生为调查研究对象,运用六维职业认同感问卷进行调查,采用方差分析和多元线性回归方法进行统计分析.方差分析结果表明,职业认同感问卷各维度得分在不同个体特征之间差异有统计学意义(P＜0.01);多元线性回归结果显示,职业认同感与部分个体特征间具有负相关,职业认同感受不同年级、高考志愿等个体特征影响.

Objective To learn the current status of health literacy of residents in Wenling City, and to explore the relationship between health literacy and socioeconomic status. Methods A total of 3200 residents aged 15-69 years old from 6 townships were selected by stratified multi-stage random sampling method and probability proportionate to size sampling (PPS) method, and a questionnaire surveyed was conducted. Results Totally 3189 questionnaires were effective and the overall level of health literacy of residents was 19.79％ (631/3189) . The percentages of residents who had the basic health knowledge and concept, healthy lifestyle and behavior, health related skills were 23.27％、 24.21％ and 23.83％, respectively. About 55.47％ of residents had the literacy of safety and first-aid, which was the highest, followed by 38.66％ with scientific health belief, 32.77％ with literacy for disease prevention, 26.12％ with health information, 14.14％ with primary medical care and 7.49％ with the literacy for chronic disease prevention. Logistic regression model showed that the health literacy level with institutions class was 2.25 times of manual workers class, and the health literacy level of people have bachelor degree or above was 6.93 times less literate or illiterate, and the health literacy level of family income of 200 thousand Yuan and above was 7.70 times of 0～50 thousand Yuan. The health literacy were different among different socioeconomic status residents (P<0.01) . Conclusion There are obvious gaps in health literacy among different socioeconomic status groups. Health education should be strengthened among residents, especially among the manual workers class, low education class and low income class.

Objective To analyze the medical service capacity of primary healthcare in Zhejiang province since the ongoing healthcare reform and put forward suggestions. Methods Key indicators of healthcare resources and medical service utilization from 2009 to 2015 reflecting the primary healthcare were identified,for a quantitative analysis in terms of the structure-process-outcome dimensions. Results In terms of structural service capacity,the average headcount growth rate of primary healthcare′s technical personnel was 5. 7% per year; the personnel competence structure kept improving; the hospital beds at primary institutions and their ratio among all were slightly decreased,with better devices and informatization. In terms of procedural service capacity,the proportion of primary institutions with contract-based services amounted to 89. 9%,with the standard contract signing rate up to 18. 8%. In terms of consequential service capacity,the average growth rate of the number of outpatient visits at primary institutions was 6. 3%. The amount and proportion of inpatients were slightly decreased,while the hospital bed utilization ratio was increased slightly. Conclusions It is necessary to further strengthen the training and introduction of primary healthcare professionals. The functional orientation of hospitals at various levels should be clarified, encouraging contract-signing of general practitioners, promote the medical insurance payment reform featuring the capitation payment at primary level,and improve the income distribution and incentive mechanism.

目的 对我国县级妇幼保健机构的卫生资源配置进行评价,探索优化资源配置的措施和途径,为卫生规划和深化卫生改革提供政策建议.方法 用数据包络分析方法,对全国27个省(自治区)的县级妇幼保健资源配置的横向及纵向效率进行相对有效性评价.结果 浙江、江苏、江西和广西等4个省份的县级妇幼保健资源配置效率呈相对有效;2005-2011年和2013年的规模报酬均递增,2014年卫生资源配置效率相对有效,规模效率不变.结论 建议加强区域卫生规划,适当调整县级妇幼保健资源配置结构和规模.

Objective To examine the occupational stability,training needs and capacity building requirements of the general practitioners purposely trained to work in rural communities,for improvement of policies regarding their training and issues related. Methods There counties were selected by stratified random sampling, where general practitioners graduated from such training completed an anonymous questionnaire. Focus group interviews were made to officials of the local Health and Family Planning Commission,those of primary healthcare institutions,and general practitioners themselves. Results The of the 190 valid questionnaires recovered, male accounted for 34. 2% and female 65. 8%. These general practitioners were mostly satisfied with their working environment, social status, work stress and job achievement,yet with lower satisfaction with their salary and availability of medical devices. Consideration of resignation was reported by only 5. 3% of them,with more males than females. As high as 63. 2% of them prefer to work in hospitals of county level. 91. 1% of them held it as necessary to participate in standard resident training,and 98. 4% held it as necessary to have on-job training. 94. 7% of them have participated in further education to gain a bachelor degree in medicine. Conclusions These doctors were found with high stability to work in rural communities and low turnover intention. Further studies are required to encourage these general practitioners to serve rural communities in a long term, and to improve the standard resident training mechanism,and their career development.

目的 比较浙江省部分地区不同社会阶层城市居民生命质量的差异,探索影响居民健康的主要社会因素.方法 采用分层抽样的方法,依据SF-12量表测定1007名浙江省城市居民的生命质量;用多元线性回归分析影响城市居民生命质量的因素.结果 所调查的城市居民躯体健康(Physical Component Summary,PCS)得分为50.1±7.1分,精神健康(Mental Component Summary,MCS)得分48.9±7.2分.影响PCS得分的因素从高到低依次为慢性病、社会阶层、年龄和性别,影响MCS得分的因素主要为社会阶层和慢性病;差异均有统计学意义(P＜0.05).结论 浙江省部分地区城市居民的生命质量一般,社会阶层越低,生命质量越差,需重点关注慢性病患者和低社会阶层的健康状况.

目的:评价浙江省经济欠发达地区基层医疗机构的影像设备:彩超、黑白B超、直接数字化X射线摄影系统(DR)、计算机X成像(CR)、X光机和CT的配置现状和公平性,指导浙江省“十三五”期间医疗设备合理配置.方法:以浙江省35个经济欠发达县(市、区)的所有基层医疗卫生机构为研究对象,资料来源于浙江省卫生和计划生育委员会2014年医疗设备配置现状和规划调查数据,采用SPSS17.0和Excel 2007对数据进行统计描述、Lorenz曲线和Gini系数分析.结果:在6种影像设备中,以彩超、黑白B超和X光机的配置最为齐全,以彩超、黑白B超和直接数字化X射线摄影系统(DR)的购置需求最为迫切.彩超、黑白B超和X光机按照服务人口分布的公平性较好,DR、CR和CT的公平性较差,处于警戒状态.结论:浙江省欠发达地区的基层医疗机构中影像设备配置受到经济、地理和政策等因素的影响.

Objective To explore the economic performance after the performance‐based reform at primary medical institutions in Zhejiang Province and put forward measures for improving primary medical services .Methods Questionnaire investigation was conducted among 84 primary medical institutions with staff over 20 .The financial statements of these institutions during 2009‐2014 were collected and studied as well .Results The average outpatients and emergency patients in 2014 increased 113.3% than that in 2009 .The total usage times of laboratory tests and other auxiliary examinations also increased(55.7% and 103.1% ,respectively ) ,yet with a decrease of inpatients.Moreover ,the proportion of income from traditional Chinese medicine (TCM )in gross income increased from 9.39% in 2009 to 17.14% in 2014 .The cost‐profit ratio of TCM drugs at half of such institutions exceeded 120% . Conclusions The performance‐based reform has motivated medical staffs of primary medical institutions and effectively vitalized such institutions.Rules and regulations of these institutions require further improvement .