Hypertension remains a major public health challenge in China. Leisure-time physical activity (LTPA) is critical for hypertension control. Yet its social network determinants, particularly key role models, are understudied in China’s familial-centric cultural context. This sequential mixed-methods study integrated quantitative surveys with qualitative interviews among hypertensive patients in Yichang, China. A total of 2639 patients were selected from 18 primary healthcare institutions using multi-stage random sampling method. Totally, 10,550 social relationships were nominated. Quantitative data on LTPA was measured by the International Physical Activity Questionnaire Long Form, and social network characteristics (size, density, LTPA aggregation, LTPA heterogeneity, and LTPA status of specific members) was gathered through the name generator method. Generalized additive mixed models assessed nonlinear associations between social network characteristics and LTPA levels (individual-level, n = 2639); mixed-effects logistic regression analyzed member-patient LTPA linkages (relationship-level, n = 10,550). Qualitative data (n = 37) via interviews underwent grounded theory coding to contextualize mechanisms. Among participants, 70.56

ObjectivesThis study aimed to develop a patient-reported questionnaire to assess service utilization and patient satisfaction among older adults with hypertension and diabetes in primary health-care centers operating under China’s National Essential Public Health Service Program (NEPHSP).MethodsThe questionnaire’s item pool was constructed on the basis of a logic model. A cross-sectional survey was conducted in three provinces of mainland China between November and December 2019. The questionnaire was evaluated using Cronbach’s alpha coefficients and confirmatory factor analysis (CFA) to refine items and assess internal consistency, construct validity, convergent validity, and discriminant validity.ResultsThe final questionnaire adopted a second-order factor model comprising three domains: essential services for all older adults, follow-up services for older adults with hypertension or diabetes, and patient satisfaction assessment. Through a two-step refinement process, nine factors encompassing 29 items were selected, including elements such as “health records and health education,” “blood pressure/glucose monitoring,” and “health education in follow-up.” Cronbach’s alpha coefficients indicated excellent reliability, with values of 0.899 and 0.906. The 29-item instrument had robust model fit for both hypertension and diabetes cohorts. The fit indices for the hypertension model included a Bollen–Stine bootstrap chi-square to degrees of freedom ratio (χ2/df) of 1.78, root mean square error of approximation (RMSEA) of 0.03, and goodness-of-fit index (GFI) of 0.97. Similarly, for the diabetes model, the fit indices were a Bollen–Stine bootstrap χ2/df ratio of 1.38, RMSEA of 0.02, and GFI of 0.97. CFA revealed factor loadings ranging from 0.516 to 0.940 for the hypertension model and from 0.504 to 0.943 for the diabetes model. All three first-order factors were significantly correlated with each other (p < 0.01), and their correlation coefficients were lower than the square root of the average variance extracted. The models demonstrated strong structural validity, convergent validity, and discriminant validity.ConclusionA valid and reliable questionnaire for evaluating service utilization and patient satisfaction among older adults with hypertension and diabetes in primary health-care center was developed in China. This instrument will serve as a practical tool for patient-reported assessments within the NEPHSP framework at primary health-care centers.

Abstract Purpose This study aimed to develop and refine an assessment tool for assessing chronic disease management outcomes in older adults based on the National Essential Public Health Services Program (NEPHSP) in China, and to validate its reliability and validity. Methods The development of the assessment tool involved generating 40 potential items through a comprehensive review and logical model analysis of the NEPHSP. Data were collected through a survey conducted as part of the 10-year evaluation project of the NEPHSP in China, which took place from November to December 2019. The assessment tool was evaluated using Cronbach's alpha coefficients and confirmatory factor analysis (CFA) to select and scale potential items, assess internal consistency, establish construct validity, evaluate convergent validity, and confirm discriminant validity. Results The assessment tool was structured around a second-order factor model comprising three domains: essential health services for all older adults, follow-up service for older adults with hypertension or diabetes, and self-assessment of patient experience satisfaction. After a two-step process, nine factors and twenty-nine items were selected, including elements such as 'health records and health education,' 'blood pressure/glucose monitoring,' and 'health coaching in follow-up,' among others. The Cronbach's alpha coefficients were excellent, measuring at 0.899 and 0.906. The 29-item instruments demonstrated strong fits in both hypertension and diabetes models. Fit indices for the hypertension model included Bollen-Stine bootstrap χ²/df = 1.78, RMSEA = 0.03, and GFI = 0.97. For the diabetes model, the indices were Bollen-Stine bootstrap χ²/df = 1.38, RMSEA = 0.02, and GFI = 0.97. Confirmatory factor analysis (CFA) revealed factor loadings ranging from 0.516 to 0.940 for the hypertension model and from 0.504 to 0.943 for the diabetes model. All three first-order factors were significantly correlated with each other (p < 0.01), and their correlation coefficients were lower than the square root of AVE. Models had favorable structural validity, convergent validity, and discriminant validity. Conclusions A valid and reliable assessment tool for evaluating hypertension and diabetes management in the older adults was successfully developed in China. This study provides robust evidence for the internal consistency reliability and structural validity of the tool. Furthermore, it serves as a foundational step for future tool refinement and holds promise for broader applications in essential public health and community healthcare program evaluations. However, further validation in these contexts is warranted.

背景 国家基本公共卫生服务项目自2009年至今已开展13年，是我国迄今为止针对高血压患者开展的最大范围的人群干预实践，了解该人群对干预实践的反馈，对于推动国家基本公共卫生服务的持续发展非常重要。目的 探讨高血压患者的国家基本公共卫生服务自评受益率与满意度，为促进国家基本公共卫生服务实现高质量发展提供科学依据。方法 采用多阶段分层抽样方式，于2019年11—12月在我国东、中、西部地区5市10区（县）20个社区卫生服务中心或乡镇卫生院抽取2 419例≥35岁的高血压患者进行问卷调查。问卷由两部分组成：一般人口学信息和高血压患者健康管理情况。结果 86.26%（2 072/2 402）的调查对象认为其所接受的基本公共卫生服务对其健康改善具有帮助。分别有97.15%（2 349/2 418）、94.09%（2 275/2 418）、88.16%（2 129/2 415）、87.81%（2 118/2 412）、61.36%（1 469/2 394）、95.04%（2 297/2 417）、83.67%（2 013/2 406）、82.34%（1 981/2 406）、95.53%（2 310/2 418）的高血压患者对医护人员服务态度、医护人员服务水平、体格检查、健康教育、中医药治疗、随访服务、高血压并发症筛查、血压控制效果及总体服务表示满意。不同文化程度、不同自评健康状况、是否在基层首次发现血压异常、过去1年内接受不同随访服务次数的高血压患者的自评获益率比较，差异有统计学意义（P＜0.05）；不同文化程度、是否在基层首次发现血压异常、过去1年内接受不同随访服务次数的高血压患者总体服务满意度比较，差异有统计学意义（P＜0.05）。结论 高血压患者的国家基本公共卫生服务自评受益率及满意度较高，应注重国家基本公共卫生服务的规范提供及城乡同质化，以促进国家基本公共卫生服务实现高质量、可持续的发展。

BackgroundThe national essential public health services (NEPHS) , which have been implemented since 2009, may be the largest population-based intervention practice for Chinese patients with diabetes currently. It is important to understand the utilization and management effect of such services in diabetic population over this period of more than 10 years of development.ObjectiveTo understand the utilization and management effect of NEPHS as well as their association in Chinese type 2 diabetics.MethodsBy use of multi-stage stratified sampling, 1 527 type 2 diabetics (≥35 years old) were selected from 20 community (township) health centers in 10 districts (counties) of 5 cities in eastern, central and western China during November to December 2019. Sociodemographic characteristics, utilization and management effect of NEPHS in these patients were collected by face-to-face surveys with a self-designed questionnaire.ResultsAccording to the survey, patients' self-reported rates of creating health records, use of health records, undergoing standardized blood glucose tests, and receiving standard follow-ups were 90.34% (1 375/1 522) , 52.80% (725/1 373) , 83.69% (1 262/1 508) , and 90.18% (1 377/1 527) , respectively. Household follow-ups and hospital follow-ups accounted for 29.24% (443/1 515) and 61.06% (925/1 515) of the total last follow-ups, respectively. The analysis of management effect showed that patients' self-reported rates of home-based self-monitoring blood glucose and regular medication in the past 6 months were 53.57% (818/1 527) , and 89.26% (1 363/1 527) , respectively. The rates of patients who were satisfied with glycemic control, and overall medical services assessed in the last follow-up were 65.23% (996/1 527) , and 95.15% (1 453/1 527) , respectively. In those≥65 years old, the prevalence of home-based self-monitoring blood glucose differed significantly by the creation of health records and Chinese medicine services (P<0.05) . The prevalence of regular medication differed significantly by number of follow-ups (P<0.05) . The level of overall satisfaction with services differed significantly by the access to personal medical records at any time, Chinese medicine services, number of home-based self-monitoring blood glucose, and type of follow-up (P<0.05) . In those aged from 35 to 64, the prevalence of home-based self-monitoring blood glucose differed significantly by the creation of health records, access to personal medical records at any time, Chinese medicine services, number of blood glucose testing, and number of follow-ups (P<0.05) . The prevalence of regular medication differed significantly by the type of follow-up (P<0.05) . The satisfaction rate of blood glucose control differed significantly by access to personal medical records at any time (P<0.05) . The overall service satisfaction rate differed significantly by follow-up type and creation of health records (P<0.05) .ConclusionNEPHS have influenced community-based management of type 2 diabetic patients, the standard implementation of which has enhanced the management effect and the overall service satisfaction in these patients.

目的 了解我国三级肿瘤医院多学科诊疗(MDT)模式开展现状,为进一步推广MDT诊疗模式和改善医疗服务质量提供参考.方法 2021年1月-3月,第5次"全国改善医疗服务行动第三方评估"项目组在全国30个省(自治区、直辖市)的33家省级三级肿瘤医院对2019年度MDT开展情况进行问卷调查.使用SPSS 25.0软件对数据进行描述性统计和矩阵分析.结果 32家MDT开展例数中位数为1158.8例,32家确诊为肿瘤的患者例数中位数为22043.5例,27家MDT诊疗方案依从率中位数为93.8％,31家MDT开展率中位数为3.98％.中部地区三级肿瘤医院MDT开展率中位数和MDT诊疗方案依从率中位数高于东部地区和西部地区的肿瘤医院.MDT开展率和MDT诊疗方案依从率均高的医院共10家,主要分布于中部地区(40.0％)和东部地区(40.0％);MDT开展率和MDT诊疗方案依从率均低的肿瘤医院共11家,主要分布在西部地区(63.6％).结论 我国医疗机构对肿瘤MDT模式探索起步较早,但MDT开展率仍较低,且地区间、院际间MDT诊疗模式发展不平衡.在推广肿瘤MDT诊疗模式过程中,国家层面需建立统一的MDT诊疗规范和标准;医院层面需加强交流与合作,充分利用信息化技术实现资源共享及协同创新,并构建合理的医师绩效激励体系.

As an important measure to deepen the reform of the medical and pharmaceutical health system, the national essential public health services programs has been carried out for more than ten years. Therefore, it is of great significance to evaluate the effect and remaining problems of the programs over the decade of implementation period (2009-2019) and to further promote the country's basic public health services. With reference to Donabedian quality theory, this paper summarized and analyzed the key problems existing in China's basic public health services from the aspects of project objectives, project contents, operation mechanisms, implementation processes and effects, and make relevant suggestions from six aspects, mainly as follows: based on scientific reasoning, dynamically adjusting the programs; suggestion that the national basic public health services should be graded and managed by classification; timely revision of project specifications to improve service quality and efficiency; gradually promoting the effectiveness-oriented evaluation and assessment system; improving operational mechanisms and promoting sustainable development; fully playing the role of county medical community, and enhancing service coordination; establishing a scientific and long-term monitoring mechanism for national essential public health services programs. It provides reference for further improvement and optimization of national essential public health services progjects.

Background The national essential public health services programs (NEPHSP) is an important project led by the Chinese government to benefit the people, which is a Chinese practice towards universal health coverage. In 2009, the project was rolled out across the country, and its coverage and influence are second to none in the field of public health in China. It is necessary to review the 10-year progress of the project and clarify its effectiveness to maintain its sustainable development. Objective To systematically sort out and summarize the progress and achievements of the NEPHSP made over the past decade (2009-2019) . Methods We collected the monitoring data (2009-2016) of basic public health projects in 31 provinces (autonomous regions and municipalities directly under the central government) through correspondence, analyzed the monitoring data of the national basic public health service management platform (2017-2019) and the relevant indicators of the China Health Statistical Yearbook (2010-2020) , and analyzed the coverage of basic public health services in the country over the past ten years from the perspective of providers. From November to December 2019, a ten-year assessment survey of the national essential public health services was carried out in Zhejiang Province, Shanxi Province and Chongqing city to investigate the residents' awareness, utilization, satisfaction and self-assessment benefit rates of NEPHSP from the perspective of the consumers. Results During the past decade, the coverage of various service items of basic public health in China has increased significantly: (1) the rate of construction of health file, the rate of construction of electronic health file, and the utilization rate of health file have increased from 48.78%, 35.07% and 22.14% in 2009 to 88.25%, 86.82% and 55.34% in 2019, with an average annual growth rate of 6.41%, 10.92% and 15.62% respectively; (2) A total of 6.311 billion printed health education materials were distributed nationwide, about 337million audio-visual health education materials were broadcasted, and a total of 1.144 billion people attended health education lectures; (3) By 2019, there were about 109 million registered hypertensive patients and about 31 357 100 diabetes patients nationwide. The standardized management rate of hypertensive / diabetes patients has increased by 29.28% and 27.25% respectively in the past decade. The blood pressure / blood glucose control rate in the population managed for hypertension / diabetes has increased by 16.84% and 24.69% respectively in the past decade, with an average annual growth rate of 3.28% and 5.56% respectively. The gap in each indicator among the eastern, central and western regions was gradually narrowing; (4) The rates of early pregnancy enrollment, antenatal examination, postpartum visit and system management increased by 6.06%, 4.60%, 7.79% and 9.40% respectively. The ten-year rates of neonatal visit and health management of 0-6-year-old children increased by 14.09% and 17.82% respectively, with an average annual growth rate of 1.74% and 2.30%. In 2019, the national elderly health management rate was 67.41%, an increase of 26.23% over 2009, with an average annual growth rate of 5.96%. The average annual growth rate of TCM health management services for the elderly and children was 15.00% and 12.97%, respectively; (5) The rate of establishing vaccination certificates and the vaccination rate of all kinds of vaccines among residents were stable at more than 90%; The standardized management rate of patients with severe mental disorders reached 89.17% in 2019, the management rate of pulmonary tuberculosis patients and the regular drug taking rate of pulmonary tuberculosis patients had been stable at more than 95% since 2015; (6) In 2019, the awareness rate of the national essential public health services programs for participating residents in the survey was 85.4%, the service utilization rate was 98.7%, the service satisfaction of the key groups was more than 90%, and the self-assessment service benefit rate was more than 85%; (7) The service capacity of primary medical and health service institutions had been improved, and the number of institutions had shown a continuous upward trend. The number of personnel in primary medical and health institutions, the proportion of doctors and nurses, and the proportion of Bachelor degree or above had all increased year by year. Conclusion Over the past decade, as an important part of basic health services in China, the population coverage of basic public health services had increased significantly, the goal of wide service coverage had been basically achieved, the health management level of the focused population had been significantly improved, the effect of health management had been presented, the residents' sense of access to basic public health services had been gradually improved, and the service capacity of basic medical and health institutions had been continuously improved. The comprehensive implementation of basic public health services in China is an important initiative towards the goal of "universal health coverage".

Objective To construct an effect-oriented comprehensive evaluation index system for national basic public health services, and to provide methods and tools for innovating evaluation method of basic public health projects and promoting the transformation from process evaluation to health outcome evaluation. MethodsPrimary, secondary and tertiary indexes were constructed and selected with literature review, field interview of senior professionals, expert Delphi consulting and logical analysis; subjective and objective weights of the indexes were calculated through analytic hierarchy process and entropy weight method. ResultsThrough literature analysis and interview consultation, an index pool consisting of 3 first-, 25 second- and 104 third-level indicators was preliminarily formed, including 47 third-level indicators reflecting health effects. For the first round of expert Delphi consultation on indicator screening, the positive coefficient of experts is 97.5%, the expert authority coefficient is 0.82, and the expert familiarity coefficient is 0.88. The final comprehensive evaluation index system consists of three first-level indexes of project investment, implementation and health effect, with the weights of 11.35%, 26.48% and 62.18%, along with 20 second- and 54 third-level indexes. Among the health effect indicators, the weight of awareness of and satisfaction to health services was the highest (16.39%), followed by the weight of health management in chronic disease patients (14.97%), children′s health management (12.42%), maternal health management (12.42%), and health education (5.43%). Among the three-level effect indexes, the weight of residents′ satisfaction to health service was the highest (7.25%), followed by the incidence of hypertension and diabetes complications in the managed population (5.35%) and the incidence of diabetes complications in the managed population (5.27%). Besides the health statistics from routine monitoring system in China, the electronic health records in residents′ information system can be used as a main data source for health effect indicators. ConclusionThe comprehensive index system constructed in this study for the evaluation on essential national public health service is effect-oriented and can be used for regular and periodical evaluation on the basis of making full use of residents′ health records in the basic public health information system.

Objective:To analyze the practice and experience of " patient-centered, popularizing multi-disciplinary team(MDT) mode" in medical institutions, and to put forward reasonable suggestions and opinions for medical institutions to further improve and popularize MDT mode.Methods:Based on the evaluation of China Healthcare Improvement Initiative, 40 typical cases of MDT in medical institutions were collected, and descriptive analysis and textual analysis were carried out on the cases.Results:There were more specialized hospitals carrying out MDT, the application scope of MDT services was constantly expanding, and the management system and diagnosis and treatment process were constantly optimized.Conclusions:The mode of MDT in China is in the stage of exploration and development. In the promotion process, it is necessary to give full play to the role of information means, establish scientific and reasonable cost measurement and charge standard, and improve the enthusiasm of medical institutions and medical personnel to participate in MDT.

Objective:To evaluate the implementation of the China Healthcare Improvement Initiative(CHII)from 2018 to 2020 in 143 tertiary public hospitals in China.Methods:In March 2019 and from January to March in 2021, 143 tertiary public hospitals in 31 provinces of China were investigated using the unified " medical institution questionnaire Ⅰ" and " medical institution Questionnaire Ⅱ" . The data were collected by means of hospital self-report and expert on-site scoring. Descriptive and inferential statistical analysis were used to analyze the data, and the data of two cross-sectional surveys were compared and analyzed.Results:The average score rate of implementing CHII in 143 sample hospitals in 2020 was 88.9%, which was higher than that in 2018(84.4%). The appointment diagnosis and treatment system, clinical pathway management system, day service, smart hospital and humanistic service were significantly improved. In 2020, the average score rate of logistics service, high quality nursing service and clinical pathway management system was higher than 95%, while the average score rate of day service, telemedicine system and medical social work system was lower than 85%. The total score rate of general hospitals was significantly higher than that of specialized hospitals( P<0.001). In 2020, the proportion of hospitals with full marks in 29 secondary indicators(74.4%)was more than 80%, reaching the standard level. Conclusions:The implementation level of CHII in tertiary public hospitals in China has been improved continuously and made significant progress, but some dimensions and indicators need to be further improved.

目的:利用扎根理论探讨基本公共卫生服务提供质量的影响因素,为促进高质量均等化的基本公共卫生服务提供建议与参考.方法:2019年11-12月,采用目的抽样法抽取浙江省、山西省、重庆市进行调查,对3省市的基层医疗机构管理人员进行访谈,并对转录资料进行三级编码分析.结果:通过三级编码抽象出基本公共卫生服务提供重要影响因素9个,并将其归纳为基层公共卫生人力资源、基层医疗卫生机构建设和外部环境3个层面,形成基本公共卫生服务提供影响因素的框架.外部政策环境会影响基层医疗卫生机构建设和基层公共卫生人员现状,二者的能力及水平会直接影响服务项目提供的质量;居民的认知会影响其对基本公共卫生服务的利用.结论:应该增强人员与机构的整体服务能力,建立健全人才引进机制,减轻基层工作负担,加大项目宣传力度.

Objectives: To understand the research landscape and identify the research hotspots and trends of the application of social network theory and analysis to public health. Study design: A bibliometric study of publications regarding application of social network theory and analysis to public health.Methods: Choosing 1607 articles about the application of social network theory and analysis to public health from the core collection database of Web of Science published from 1991 to 2020 as the research sample. A biblio-metric and visual analysis of publication quantity and content was performed to analyze time trends, spatial distribution, cooperation networks, influential references, and keyword co-occurrence, clusters, and emergence. Results: There is an increasing trend in the use of social network theory and analysis in the public health field, with the United States taking the lead. Research focuses include on transmission of diseases or behavior through social networks and the influence of social networks on population health at different ages. Current research frontiers primarily include the role of social networks in tracking of emerging infectious diseases like COVID-19, preventing and controlling chronic diseases, and carrying out healthy behavioral interventions.Conclusions: This study provides a comprehensive quantitative overview of the historic development of and latest topics in the application of social network theory and analysis method to public health. More attention should be paid to the important role of social networks in tracing the emergence of serious infectious diseases like COVID-19, as well as preventing and controlling chronic diseases and intervening in health behaviors, considering the increasing challenges and opportunities presented by online social networking.

Objective:To understand the practice of humanistic care and social worker voluntary service in public hospitals in China.Methods:From January to March 2021, 38 typical cases concerning " medical social worker and volunteer system" and " building a harmonious doctor-patient relationship through humanistic service" were collected by relying on the evaluation of China Healthcare Improvement Initiative. By means of statistics on the frequency of the subject words in the cases, hotspots of these hospitals in " paying attention to medical humanistic care and promoting social work voluntary service" were identified.Results:By classifying the keywords of the 38 cases, the hotspots mainly focused on strengthening the construction and management of social work volunteer platform and team, providing convenient and high-quality services, integrating humanistic care into diagnosis and treatment services, and building characteristic brand projects.Conclusions:The concept of humanistic care should be integrated into the hospital culture construction, the standardized and institutionalized development of humanistic care and volunteer work in the hospital should be promoted. Supporting measures should be introduced to promote the professional and stable development of talent team, and the routine service system should be established based on the needs assessment of both doctors and patients.

背景 国家基本公共卫生服务已经实施十多年并取得了一定的成效,基层基本公共卫生服务从业人员作为服务的直接提供者,研究其工作的满意度及影响因素,有利于提高服务的质量与效率.目的 了解基层基本公共卫生服务从业人员总体工作满意度及其影响因素,并提出相应的建议.方法 于2019年11—12月,从浙江省、山西省、重庆市3个省(市)分别选取2个市辖区作为调查地区,其次依据各地区社区卫生服务中心/乡镇卫生院名单进行方便抽样,共抽取53个基层医疗卫生机构,每个机构至少随机调查10例基本公共卫生服务的从业人员.利用自行设计问卷对553例从事基本公共卫生服务的医务人员进行调查,问卷内容包括一般人口学特征、工作总体满意度及10项满意度因子.结果 回收有效问卷553份,基层基本公共卫生服务从业人员工作总体满意得分为(3.66±0.77)分,60.5％(334/552)从业人员对总体工作感到满意或非常满意.在各项满意度因子中,医患关系得分最高,为(3.84±0.68)分,工作强度满意度最低,为(2.86±0.81)分.多因素逐步Logistic回归分析结果显示,社会尊重、绩效考核、工作能力和工作强度是基本公共卫生从业人员工作总体满意度的影响因素(P<0.05).结论 从事基本公共卫生服务的医务人员工作总体满意度一般,应增强社会公众对基本公共卫生服务从业医务人员的尊重,优化绩效考核制度,减轻工作负荷,提高从事基本公共卫生服务医务人员的工作满意度.

目的:了解"进一步改善医疗服务行动计划"(简称"行动计划")实施以来,我国三级公立医院医疗服务改善情况,重点了解2018年现况,为医院有针对性地补短板、为政府进一步推进"行动计划"提供决策依据.方法:对我国31个省(自治区、直辖市)及新疆生产建设兵团的100多家省级及以上三级公立医院,采用国家统一下发的"进一步改善医疗服务行动计划考核指标体系(医疗机构)",通过专家现场评分方式收集数据,以得分率(医院得分/满分*100％)来表示各家医院对"行动计划"的落实程度.结果:"行动计划"第一阶段(2015—2017年)样本医院每年总得分率均值均在90％左右,且不断提升.九个维度在2017年得分率均值均达到90％以上或左右,"推进预约诊疗服务、有效分流就诊患者""发挥信息技术优势、改善患者就医体验"的改善幅度最为显著,得分率均提高了10个百分点以上.第二阶段开局之年(2018年)样本医院总得分率均值为84.4％,东部、中部地区医院总得分率均值高于西部,委属委管医院高于地方医院,综合医院高于各专科医院(中医医院、妇幼医院和其他专科医院).在第二阶段评估的十二个维度中,"后勤服务"得分率最高(97.2％),"日间服务"最低(51.8％).结论:自"行动计划"实施以来,我国省级及以上主要三级公立医院医疗服务改善情况总体良好,但"不平衡"问题凸显,部分医院和短板领域尚需进一步改善.

This study analyzed the barriers of patient access to affordable MDR-TB medication in China and the reasons behind, and proposed strategies towards removing the barriers based on literature review and key informant interviews. Reasons behind the high financial burden of MDR-TB patients in China are the lack of a coordinated and multi-sourced financing model to secure patients' access to the expensive novel medicines, and the absence of the safety-net for the patients with low ability to pay the costs. Appropriate health insurance benefit packages and provider payment mechanisms, supportive legal framework, coordinated policies as well as incentives for off-label use of evidence-based repurposed medicines are missing. The observations identified key intervention areas including continued efforts to make the novel effective medicines affordable and to strengthen the legislative protection for off-label use of evidence-based medicines; increase incentives for pharmaceutical companies to expand indications of established medicines based on the evidence; implement public initiatives to support the use of repurposed medicines for diseases with major public health significance, and scale up good practices from local pilots to create a coordinated multi-sourced financing model. A comprehensive approach to address the barriers in the full treatment course of MDR-TB and a safety-net for low-ability-to-pay patients are also critical to secure universal access to affordable MDR-TB medication.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:了解临床医生的工作时长与医疗差错之间的相关性,为提高医疗服务质量提供科学依据。方法:2018.1～2018.4,采用问卷调查法进行资料收集,在湖北省内抽取了8家医院临床医生作为调查研究对象,回收问卷555份,运用描述性及卡方检验的统计学方法进行相关性分析。结果:调查结果显示,89.65%的临床医生每周工作时长&gt;40小时,22.27%的临床医生在近6个月内发生过医疗差错。工作时长、文化程度、熬夜和加班情况与医疗差错事件的发生具有显著相关性（P&lt;0.05）,且每周工作时长会显著影响治疗差错、病案书写差错以及用药差错的发生。结论:为减少医疗差错事件的发生,应控制医生工作时长,保障充足的休息时间。</span>

目的:分析全国143家不同类型医院的医院感染和多重耐药菌感染情况,为有效预防和控制医院感染提供科学依据.方法:采用2018年"全国进一步改善医疗服务行动计划第三方评估"调查数据.结果:全国143家三级公立医院的医院感染发病(例次)率为1.15％,医院感染现患(例次)率为2.26％,医院感染病例漏报率为5.30％.综合医院的医院感染发病率和现患率最高,分别为(1.48±0.91)％和(3.12±1.49)％,妇幼医院最低,分别为(0.83±0.71)％和(1.65±1.27)％,差异具有统计学意义(P<0.05).全国143家三级公立医院耐碳青霉烯鲍曼不动杆菌感染发现率最高(1.69％),其次为耐甲氧西林金黄色葡萄球菌感染发现率(1.12％),耐万古霉素肠球菌感染发现率最低(0.07％).耐碳青霉烯鲍曼不动杆菌感染检出率最高(39.25％),其次为耐甲氧西林金黄色葡萄球菌感染检出率(26.6％)和耐碳青霉烯铜绿假单胞菌感染检出率(19.49％),耐万古霉素肠球菌感染检出率最低(1.48％).结论:我国三级公立医院医院感染总体发生和控制情况较好.建议相关部门应加强政策和措施的力度,多部门协作共同防控多重耐药菌引起的医院感染,加强医院感染和耐药的控制.

近年我国年轻医生“过劳死”现象频发,医护人员“过劳”不仅影响身心健康,而且给医疗安全带来巨大隐患.对“过劳”的内涵及研究发展趋势、“过劳”的测量与评估、医护人员“过劳”形成机制及危害进行相关文献研究,发现国内医护人员“过劳”问题未引起足够重视.相较于国外,国内针对医护人员“过劳”危害研究较少,医护人员“过劳”形成机制缺乏系统性分析等,以为进一步开展医护人员“过劳”实证研究,缓解医护人员“过劳”问题提供参考依据.