Chinese General Practice

Learning from the Outside World：Implications of American Quality Measurement Strategy for Primary Care for Quality Measurement System of General Practice in China　

WANG Yang，HAN Jianjun，XU Yanli

2019, 22(16): 1889-1899. DOI: 10.12114/j.issn.1007-9572.2019.00.293

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As the reform of public health services in the United States is underway，primary health care has played a key role in its reform in recent years.In December 2018，the American Academy of Family Physicians（AAFP） published Vision and Principles of a Quality Measurement Strategy for Primary Care（the Principles）．It involves six core principles，including distinction between quality measures and performance measures，definitions of quality measures and performance measures，characteristics of general practice and data source standardization.This has laid a solid theoretical foundation for a new US quality measurement standard for primary care in the future.By analyzing the limitations of the traditional pay-for-performance，the methodology of quality improvement，and the theory in general practice，this article interpreted the core ideas of the Principles and compared it with quality measurement systems in the UK，EU，and Australia，so as to point out its theoretical breakthroughs in the traditional pay-for-performance model.Based on this，this article also analyzed its impact on the current quality measurement system of general practice service in China，and proposed two suggestions on formulating core performance indicators and urging support from relevant associations for self-assessment and quality improvement of general practitioners in China.

Implementation Status and Development Strategies of Specialty Services in Community Health Centers in China　

ZHANG Lifang，LIU Zhongyuan，LIN Chunmei，ZHANG Yanchun，QIN Jiangmei

2019, 22(16): 1900-1903. DOI: 10.12114/j.issn.1007-9572.2019.00.284

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Delivering specialty services is an important measure for improving the service capabilities of community health centers（CHCs） and for promoting the development of hierarchical medical system.We analyzed the status of specialty services delivered in CHCs in China by using data from China Health Statistics Yearbook 2018，and the results were summarized as follows：in CHCs，top priority is given to general practice department development，TCM department develops rapidly，rehabilitation department is promising，but pediatrics and other specialty departments lag behind.Along with the promotion of hierarchical medical system development，specialty services delivered by CHCs have been characterized to show crucial roles in improving healthcare service capabilities and revenues，promoting occupational development of healthcare providers，and enhancing residents' satisfaction with healthcare services.However，CHCs also face challenges in delivering specialty services，such as insufficient equipment allocation，specialists training，and drug use guidance，as well as lack of related supportive policies.The development of specialty services in CHCs is different from that of general hospitals，which should be promoted by developing and implementing a sound regional health plan，strengthening specialists training，increasing investment，reinforcing the implementation of incentives and medical insurance programs，improving healthcare prices，drug policies and medical environment.

Drawing Lessons from NHS Referral System to Strengthen the Hierarchical Medical Service System and Grassroots Medical Informatization in China　

ZHANG Lei，WANG Lechen

2019, 22(16): 1904-1907. DOI: 10.12114/j.issn.1007-9572.2019.00.232

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National Health Service（NHS）includes both primary health care system and hospital system.The referral letter is a means of communication between general practitioners and specialists，and the information contained therein has an impact on improving the quality and efficiency of the referral.Studying the information in the referral letter will help to provide advice for hierarchical medical service system in China.This paper systematically evaluated the relevant literatures by retrieving the guidelines and norms given by relevant organizations and drew the key indicators to form policy analysis and recommendations.The results showed that the indicators for quality control of the referral letter were mainly composed of the indicators in referral guidelines made by the National Institute for Health and Care Excellence（NICE）and the key performance indicators made by the NHS Clinical Commissioning Groups（CCG）．In England while patients were generally satisfied with the current referral service，there was still room for improvement in terms of referral options，referral expectations，referral time，and diagnosis.These findings suggested that to improve the quality of referral required standardizing the referral medical behaviours，fully enhancing the role of medical informatization in the referral，establishing a close relationship between family doctors and specialists，and introducing non-public health technicians as family doctor assistants.

History of Residency Training in Family Medicine in the United States　

DU Lixue，CHEN Jialin

2019, 22(16): 1908-1914. DOI: 10.12114/j.issn.1007-9572.2019.00.136

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By the middle of 20th century，the major advances and triumphs of biomedical research have led the American medical specialty to develop faster than general practice centered by care continuity，which eventually caused the complexity of the medical behavior.Therefore，the general practice was reappraised and confirmed as a specialty-family medicine，which prioritizes the development of education in family medicine.The history of standardized residency training can be summarized as three stages.The first stage：family medicine residency programs set the fixed rotation curriculum and duration in 1948.The second stage：the Society of Teachers of Family Medicine（STFM）introduced an alternative approach in 1990s，known as the competency-based education in residency training，which emphasized the attainment of competencies rather than the completion of a series of experiences.Afterwards，the Accreditation Council for Graduate Medical Education（ACGME）proposed the outcome project according to the competency-based education approach in 1998，requiring that US "graduate medical education programs fostered resident physicians" competencies in six domains，and changed its accreditation system.The third stage：the two graduate medical education accreditation authorities-the ACGME and the American Osteopathic Association（AOA）eventually signed the historic memorandum of understanding in 2014，which approved to create a single accreditation system for graduate medical education.It is scheduled to be implemented in June 2020 with a five-year transition period.

Calculation Strategy and Empirical Study on Labor Cost for Delivering Community-based Integrated Pension Service and Medical Service　

CHEN Hongzhu，QIU Yanqing，WANG Kang，YU Ping

2019, 22(16): 1915-1921. DOI: 10.12114/j.issn.1007-9572.2019.00.205

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Background　China's aging population becomes a very challenging problem.One major way for addressing this problem is to construct elderly care institutions delivering integrated pension service and medical service care with both medical and elderly care resources.Clarifying the labor cost for delivering integrated pension service and medical service can determine the division of labor between medical and elderly care institutions，and can provide evidence for the development of subsidy mechanism for institutions offering such services.Objective　To measure the labor cost for delivering integrated pension service and medical service in Nanxiang Community Health Center，providing a basis for calculating labor cost in offering such care in other institutions and for developing subsidy mechanism for the delivery team for incentivizing them，as well as for constructing the codelivery patterns between community health centers and community elderly care institutions.Methods　From July 2016 to January 2017，the self-made Collection Table of Integrated Pension Service and Medical Service in Community was used to collect the integrated pension service and medical service provided by Nanxiang Community Health Center.From July 2017 to January 2018，two rounds of Delphi expert consultation were adopted.We calculated the standardized value of each integrated pension service and medical service programe implemented by Nanxiang Community Health Center，and measured the labor cost during the procedure，based on basic labor cost and time consumption，difficulties and risks in implementing per program，and individual salary parameters（level of hospital，technical type，professional and technical title and so on）with reference to the National Medical Service Price Project Specification（2012 edition）．Results　The center can provide a total of 75 integrated pension service and medical service programes，some of which can be delivered independently，but to deliver the rest services，the center needs help from other institutions.Regardless of the cost of outsourcing，the average labor cost for delivering each integrated pension service and medical service is（77.41±58.50）yuan（range，8.52-283.69 yuan）．The labor cost for delivering rapid blood sugar test is lowest，while that for delivering an emergency ward round with great difficulties and risks is highest（8.52 yuan vs 283.69 yuan）．Conclusion　We developed a set of methods for calculating the labor cost of the community health center in implementing the standardized workload，which were tested to be effective in calculating the labor cost of each of the 75 integrated pension service and medical service programes delivered by Nanxiang Community Health Center.The methods can be used as an assistant tool to manage the budget and expenditure for delivering community-based integrated pension service and medical service，and to develop a subsidy mechanism for offering such services.

Supply Efficiency and Cooperation Mechanism Analysis of Community Health Services Delivery under the PPP Model　

JIA Qingping，SHI Liqin

2019, 22(16): 1922-1926. DOI: 10.12114/j.issn.1007-9572.2019.00.285

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The lack of incentive mechanism and sense of responsibility leads to insufficient efficiency of government departments in the supply of community health services.Public-Private Partnership（PPP） model，a novel favorable approach for community health services delivery，is feasible for improving the efficiency of community health system.Using SWOT analysis and economic theories，we analyzed the feasibility，efficiency and cooperation challenges of utilizing PPP model in community health sector，and concluded that the application is feasible and necessary，which can improve the supply efficiency，save health resources，and reduce the financial pressures faced by government agencies.Moreover，as for the cooperation mechanism during delivering community health services utilizing the PPP model，we put forward that it could be developed from dimensions of government investment combined with social capital，revenue sharing and risk control，by which the application and development of the PPP model in delivering community health services can be promoted.

Exploration of Specialized Medical Alliance Based on Hierarchical Diagnosis and Treatment in the Project of Joint Prenatal Examinations　

CHEN Xudong，SUN Qian，WANG Xin

2019, 22(16): 1927-1930. DOI: 10.12114/j.issn.1007-9572.2019.00.233

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Background　After the establishment of Beijing Mother and Child Health Handbook in community health service centers，pregnant women in Beijing will do all prenatal examinations and give birth in their selected midwifery institutions，which leads to much simple and repeat work and high input in prenatal examinations in midwife institutions，while in the community health service centers professional obstetricians and gynecologists have insufficient workload.Objective　To explore the development prospect of specialized medical association under the mode of hierarchical diagnosis and treatment by studying the project of Joint Prenatal Examinations for women of childbearing age.Methods　From October 2017 to October 2018，one community health service center and one tertiary midwifery institution set up a specialized medical association to carry out the project of Joint Prenatal Examinations.The pregnant women in the observation group（n=38）completed eight routine prenatal examinations in the community health service center and four prenatal examinations in the tertiary midwifery institution.After 34 weeks of gestation，they were referred to the tertiary midwifery institution for follow-up prenatal examinations and delivery.The control group（n=80）contained pregnant women in the community who were examined and delivered by other midwifery institutions at the same period and had complete records in the second phase of the Beijing Mother and Children System.Statistical analysis was carried out on the waiting time and length of visit of prenatal examinations，delivery mode and pregnancy outcome，the recovery rate of Beijing Mother and Child Health Handbook and the situation of postpartum visits of the two groups，as well as the satisfaction of parturients in the observation group.Results　The waiting time of prenatal examinations in the observation group was significantly shorter than that in the control group，and the length of visit of prenatal examinations in the observation group was significantly longer than that in the control group（P<0.05）．There was no significant difference in the delivery mode and pregnancy outcome between the two groups（P>0.05）．The recovering in time rate and total recovery rate in the observation group were higher than those in the control group（P<0.05）．The overall satisfaction score of pregnant women in the observation group who were fully involved in the project of Joint Prenatal Examinations was（90.03±1.94）.Conclusion　It is not only safe and feasible，but also scientific and advanced to establish the Joint Prenatal Examinations Project with specialized medical association under the mode of hierarchical diagnosis and treatment.

Status of Allocating High-quality Medical Resources to Primary Healthcare Institutions in Guizhou Province：a Study from the Perspective of Primary Care Providers　

ZHOU Geyao，XIONG Dandan，WANG Lingzhi，LEI Xue，CAO Yu

2019, 22(16): 1931-1935. DOI: 10.12114/j.issn.1007-9572.2019.00.281

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Background　Guizhou issued the 13th Five-Year Plan for Health and Family Planning in Guizhou Province（2016—2020），Three-Year Plan for Improving Serving Capabilities in Primary Care in Guizhou Province（2016—2018），and Outline of the Healthy Guizhou 2030 Plan，in which allocating high-quality medical resources to primary healthcare institutions were put forward to solve the problems of insufficient healthcare resources，serious shortage of talents，incomplete system and mechanism，and weak serving capabilities in primary care sector.Objective　To investigate the status of allocating high-quality medical resources to primary healthcare institutions in Guizhou Province from the perspective of grass-root level medical workers.Methods　This study was conducted in Guizhou Province from September to November 2017.Data of a questionnaire survey〔general personal characteristics（including sex，age，and so on），evaluation of the level of medical services delivered by one's own hospital，understanding and acceptance of allocating high-quality medical resources to primary care，intention of receiving such resources，and effect and problems brought by the implementation of this strategy〕 in a convenience sample of 180 medical workers from 8 primary healthcare institutions selected from Guiyang and Zunyi by use of simple random sampling，and results of in-depth interviews with 17 managers from 17 county-level or lower level medical institutions（cooperation between one's own hospital and higher level hospitals in the construction of a regional medical consortium，delivery of telemedicine and remote care，and hierarchical diagnosis and treatment，the most needed type of medical professionals from higher level hospitals，and conditions provided for such professionals，counterpart assistance from higher level hospitals，and implementation of contracted family doctor services）were analyzed.Results　Altogether，171 primary care providers returned valid responsive questionnaires，obtaining a response rate of 95.0%.Most respondents thought that the level of medical services offered by their own hospital could not satisfy patients' needs，and they thought that allocating high-quality medical resources to primary care institutions was contributive to the development of such institutions，and they were very willing to receive such assistance.The results of interviews with 17 managers are as follows：the operation of a regional medical consortium that their hospital participated in，and the cooperation of their hospital with higher level hospitals in delivering telemedicine and remote care were not ideal；although most patients had initial consultation in primary care，upward referrals were easy to execute，but downward referrals were difficult to implement；the contracted family doctor services were implemented successfully；experienced clinicians，general practitioners and nurses were needed in primary healthcare institutions；their hospital received different levels of counterpart assistance from higher level hospitals.Conclusion　In Guizhou Province，the level of serving capabilities in primary healthcare institutions is unsatisfied and needs to be improved，allocating high-quality medical resources to primary care is still in the initial stage，and the effects of ways of allocation are not good，so related policies need to be developed and supervision of the implementation of allocation needs to be enhanced by the government agencies.

The Specialists' Views on General Practitioners with Special Interests　

YING Meike，LIU Ying，REN Jingjing

2019, 22(16): 1936-1939. DOI: 10.12114/j.issn.1007-9572.2019.00.288

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Background　The introduction of the concept of general practitioners with special interests（GPwSIs） has provided a direction for the development of general practitioners（GPs） continuing medical education system，which is not yet comprehensive in China.However，it is still contraversial about the relationship between GPwSIs and specialists.Objective　To investigate the views of specialists on the development of special interests in GPs，and provide advices for the training of GPwSIs in the future.Methods　A self-designed questionnaire was used to investigate specialists by Wechat from June to July 2018.The contents include basic information，attitudes and advices towards the development of special interests in GPs.A total of 191（91.0%） questionnaires were valid in 210.Results　A total of 151（79.1%）specialists supported GPs in developing special interests，while 23（12.0%） specialists not，remaining 17（8.9%） specialists didn't express clear attitude.Multivariate Logistic regression analysis showed that attending doctors were more supportive of developing special interests than residents〔OR（95%CI）=5.280（1.103，25.280），P<0.05〕.And 167（87.4%） specialists expressed strong or less strong will to serve as clinical mentors of GPwSIs.The supporters have stronger tendency to be clinical mentors than the unclear and non-supporters（P<0.05）.And 85（44.5%） specialists recommended GPs to develop two special interests，121（63.4%） suggested special interests should be based on common diseases in community，145（75.9%） advised training could be began at Post-standardized Resident Training period.Conclusion　Specialists are highly supportive of the development of special interests in GPs.But they also reckoned that GPs should strengthen the joint training of specialists and GPs and recognize the boundary between special interests and specialty in order to ensure the quality of training.

Patient Satisfaction with Outpatient Consultation in General Practice Department in General Grade A Tertiary Hospitals：a Survey 　

LIU Mei，ZHENG Shaoru，LI He，WANG Rongying

2019, 22(16): 1940-1944. DOI: 10.12114/j.issn.1007-9572.2019.00.279

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Background　In recent years，China has repeatedly issued relevant policies to encourage general hospitals to establish general practice department.In responding to the call，general practice department has been set up in most of general hospitals with a resident physician base，and its role in hierarchical diagnosis and treatment，bidirectonal referrals and reducing medical expense has achieved universal recognition.The Second Hospital of Hebei Medical University established department of general medicine in 2013，and set up a general practice outpatient consultation office."First consulting the general practitioner，then the specialist if the health problem needs further treatment"，the concept of triage of this hospital，is completely different from the traditional one.The action can reasonably and effectively allocate medical resources and provide convenience in accessing healthcare.Objective　To explore the role of outpatient consultation office of general practice department in general grade A tertiary hospitals by surveying patient satisfaction with it.Methods　In March 2018，from the Outpatient Consultation Office of General Practice Department，the Second Hospital of Hebei Medical University，we recruited 230 outpatients and surveyed them with a self-made questionnaire，General Practice Outpatient Consultation Experience.The questionnaire has three parts：basic personal information，status and thoughts about the outpatient consultation.In total，212 of them returned responsive questionnaires，achieving a response rate of 92.2%.Logistic regression analysis was used to assess factors influencing the satisfaction of treatment experience.Results　Of the 212 respondents，109（51.4%）were first-time visitors〔including 58（53.2%）who did not know the consulting department at all〕，138（65.1%）visited the department appropriately after consulting the nurse，61（28.8%）had an experience of registering the inappropriate department，and 159（75.0%）thought that it was necessary to set up the general practice outpatient consultation office.The overall patient satisfaction with the outpatient consultation was 84.9%（180/212）．To be specific，162（76.4%） were satisfied with the length of consulting the nurse，171（80.7%） were satisfied with the detailed explanation of the nurse，165（77.8%）were satisfied with the patience and professional levels of the nurse showed in the consultation，and 193（91.0%）were satisfied with the department for treatment recommended by the nurse.Multivariate Logistic regression analysis showed that the length of consulting the nurse，patience and professional levels of the nurse showed in the consultation，and the department for treatment recommended by the nurse were associated with patient satisfaction with general practice outpatient consultation（P<0.05）.Conclusion　The level of patient satisfaction with the care delivered by outpatient consultation office of general practice department is relatively high，which are affected mainly by nurse-patient communication and the appropriation level of department for treatment recommended by the nurse.

Effects of Fast Diet on the Metabolism in Overweight Patients　

JIN Nana，XIANG Qi，MA Li，LI Xiaowei，WU Xiaoyan，JIA Suwei

2019, 22(16): 1945-1948. DOI: 10.12114/j.issn.1007-9572.2019.00.287

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Background　Obesity adds to potential for chronic diseases.Diet interventions are a kind of important approach for obesity prevention and treatment，among which fast diet may be a novel way.However，previous studies can not provide very convincing evidence about the effect of fast diet on obesity due to small sample size and inadequate analyses of action mechanism of fast diet and dose-effect relationship.Objective　To discuss the effects of fast diet on metabolic changes in overweight patients.Methods　We enrolled 86 cases from an enterprise during December 2016 to January 2017.All of them were overweight（BMI≥24.0 kg/m2） initially found by a health check-up in Tianjin Haibin Hospital.They received a 60-day fast diet therapy，during the intervention period，they ate normally for five days per week according to personal preference，but on the other discontinuous two days，they restricted their calorie intake to 600 kcal per day.Metabolism-related indicators at the day prior to the intervention and at the last day of the intervention were collected.Results　 80 patients completed the intervention.Compared with baseline，after intervention，diastolic blood pressure，body weight and body fat percentage decreased significantly（P<0.05），but systolic blood pressure and heart rate only changed insignificantly（P>0.05）；LDL-C increased significantly（P<0.05），while TC，TG，and HDL-C showed little changes（P>0.05）；fructosamine and HbA1c decreased significantly（P<0.05）；Glu showed insignificant changes（P>0.05），but 1 hPG and 2 hPG decreased significantly（P<0.05） showed by the 75 g OGTT；fasting insulin decreased obviously（P<0.05），but 1-hour and 2-hour postprandial insulin presented minor changes（P>0.05） found by insulin response test.Conclusion　Fast diet is an effective weight loss intervention for overweight people，which can obviously improve the physiological stress state and insulin sensitivity，and reduce postprandial blood sugar as well as the risk of developing overweight-related complications.

Disability Status and Its Influencing Factors among Empty Nesters and Non-empty Nesters in China　

LI Mimi，ZHANG Chichen，ZHAO Huining，ZHENG Xiao，LU Jiao，CHANG Yunqi，CAI Yuan

2019, 22(16): 1949-1953. DOI: 10.12114/j.issn.1007-9572.2019.00.243

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Background　The problem of disability not only affects the quality of life and physical and mental health of the elderly，but also puts tremendous pressure and burden on the family and society.There are differences between empty nesters and non-empty nesters in mental health and social support，so there is a reason to speculate that there may be differences in disability status between them.Objective　To get a general idea of disability status and its influencing factors between the empty nesters and non-empty nesters in China and provide references for the recognition of the elderly health care needs to achieve the healthy aging.Methods　The data of 2 023 empty nesters and 2 141 non-empty nesters aged 60 and older were picked out from China Health and Retirement Longitudinal Study（CHARLS）of 2015 in October 2017.The Activities of Daily Living（ADL）scale was used to conduct disability assessments.Binary Logistic regression was used to analyze the influencing factors of the disability in empty nesters and non-empty nesters.Results　Compared with non-empty nesters，most of empty nesters whose spouses were still living enjoyed drinking with a higher education level，and lived in the eastern and central urban areas of China（P<0.05）．The total disability rate of empty nesters was 8.1%，and that of non-empty nesters was 8.9%．There was no statistical difference（P>0.05）.Binary Logistic regression analysis showed that the common influencing factors between empty nesters and non-empty nesters included age，self-rated health status，mental health（frustration）（P<0.05）．The influencing factors of empty nesters included sleep disorders and drinking，while sex and the number of chronic diseases were the influencing factors of non-empty nesters（P<0.05）．Conclusion　The incidence of disability in empty nesters is similar to that in non-empty nesters，but the factors affecting their disability are different.While taking comprehensive interventions for the elderly，targeted prevention measures should be taken respectively for empty nesters and non-empty nesters.

Prevalence and Associated Factors of Hyperuricemia and Gout in Elderly People in Xujiahui Subdistrict，Shanghai　

WEI Ruoyan，ZHANG Yuan，ZHANG Fuliang，PENG Shuying，WANG Chunyan，XU Guangzheng，PENG Lei，SONG Yuanyuan，YANG Zhujie

2019, 22(16): 1954-1959. DOI: 10.12114/j.issn.1007-9572.2019.00.286

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Background　The prevalence of hyperuricemia（HUA） and gout in China has been increasing annually in recent years.Their distribution varies across regions.Investigating the disease characteristics and risk factors in a local area can guide the corresponding prevention and treatment services in community practice.There is no statistical analysis of HUA and gout prevalence and the distribution of such patients in Xujiahui Subdistrict，Shanghai.Objective　To investigate the epidemiological characteristics and associated factors of HUA and gout in community-dwelling elderly people aged 65 and over from Xuhui Subdistrict，Shanghai.Methods　From Xujiahui Subdistrict Community Health Center，we enrolled a total of 2 047 elderly physical examinees，some of whom were recruited between April 19 and October 27，2016，and others were recruited between September 4 and October 31，2017.We analyzed the prevalence，and sex and age distributions of HUA，asymptomatic HUA and gout in the participants，and determined the associated factors of HUA by using stepwise multiple Logistic regression.Results　The prevalence of HUA，asymptomatic HUA，and gout was 24.33%（498/2 047），23.35%（478/2 047） and 5.13%（105/2 047），respectively.Higher gout prevalence and lower asymptomatic HUA prevalence were found in male patients than in female patients（P<0.05）．No significant difference was found for HUA between males and females（P>0.05）.The HUA prevalence showed an increase with age（P<0.05） in female patients.Regression analysis indicated older age，overweight and obesity，high TG（≥1.70 mmol/L），and high ALT（>40 U/L） were independent risk factors for HUA（P<0.05）.The prevalence of hypertension，diabetes，cerebrovascular disease，coronary heart disease and osteoporosis in gout patients was much higher than in those with normal uric acid but without gout or in those with asymptomatic HUA（P<0.016 7）.Conclusion　The prevalence of HUA and gout in community-dwelling elderly people in Xujiahui Subdistrict is high，with similar HUA associated factors as found in previous studies，and the prevalence of chronic comorbidity of gout is also high，demanding for increased community-based risk management among high-risk residents，as well as prevention and treatment of comorbidity for gout patients.

Clinical Characteristics and Influencing Factors of Polymyositis and Dermatomyositis Combined with Interstitial Lung Disease in the Northeast Sichuan Province in China　

TANG Ziyi，YI Ting，WANG Dan，ZHENG Jianxiong，XIONG Qin，ZHANG Quanbo，QING Yufeng

2019, 22(16): 1960-1965. DOI: 10.12114/j.issn.1007-9572.2019.00.280

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Background　Concurrent interstitial lung disease（ILD）in patients with polymyositis（PM）and dermatomyositis（DM）is a major cause of death with a fatality rate that exceeds 50%.However，there are currently few domestic studies on the clinical characteristics and related influencing factors of PM/DM combined with ILD（PM/DM-ILD） with different results，and there is still no valid evidence to confirm which factors are related to the occurrence of PM/DM-ILD.Objective　To explore the clinical characteristics of PM/DM-ILD and its influencing factors.Methods　A total of 119 patients with PM/DM who were treated in the Affiliated Hospital of North Sichuan Medical College from January 1，2014 to June 30，2018 were selected as subjects and divided into ILD group and non-interstitial lung disease（NILD）group.The general data，clinical symptoms，laboratory parameters，results of lung high-resolution CT（HRCT）and prognosis of the two groups were compared.Stepwise Logistic regression was used to analyze the influencing factors of PM/DM-ILD.Results　The age，the first episode of arthritis，the first episode of respiratory symtom，mechanic's hand，Reynolds phenomenon，dry cough，expectoration，post-exercise shortness of breath，fever，incidence of arthritis，erythrocyte sedimentation rate（ESR），globulin（GLOB） level，positive rate of anti-Jo-1 antibody of patients in ILD group were higher than those of patients in the NILD group，while the first episode of myasthenia，creatine kinase（CK），CK/glutamic-oxalacetic transaminase（AST），albumin（ALB） level of patients in ILD group were lower than those of patients in NILD group（P<0.05）．Lung HRCT manifestations of 60 patients of the ILD group were mainly stripe shadow（68.3%，41/60），patchy shadow（68.3%，41/60），reticulate shadow（45.0%，27/60），ground glass opacity shadow（31.7%，19/60），cloud flocculent shadow（15.0%，9/60），and honeycomb shadow（10.0%，6/60），which could be seen alone or simultaneously.In NILD group，25.4%（15/59） of lung HRCT also showed a small amount of stripe shadow，patchy shadow and ground glass opacity shadow while the lesion location，distribution range and lesion degree did not meet the imaging diagnostic criteria of ILD，and most of them were old changes of previous diseases.The results of stepwise Logistic regression analysis showed that age，dry cough，post-exercise shortness of breath，arthritis，GLOB and anti-Jo-1 antibody were influencing factors of PM/DM-ILD（P<0.05）．The repetitive hospitalization rate and the rate of repetitive hospitalization caused by pulmonary infection in ILD group were higher than those in NILD group（χ2=5.275，P=0.022； P=0.010）．There was no significant difference in the treatment effects between the two groups（χ2=0.192，P=0.909）．Conclusion　Advanced age，dry cough，arthritis，post-exercise shortness of breath，positive anti-Jo-1 antibody in serum and elevated GLOB level are risk factors for PM/DM-ILD.The lung function and HRCT changes of elderly patients with above symptoms and related serological results need to be closely monitored.

Risk Factors for Various Subtypes of Hypertension in Urumqi's Check-up Population：a Multiple Correspondence Analysis　

YELEDAN·Mahan，SUN Yong，ZHANG Zhanlin，TUO Xiaoqing，GONG Zheng，TIAN Tian，CHEN Zhen，GULISIYA?Hailili，DAI Jianghong

2019, 22(16): 1966-1972. DOI: 10.12114/j.issn.1007-9572.2019.00.203

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Background　There are significant health and economic gains attached to early detection，diagnosis，and treatment，and good control of hypertension.So it is necessary to explore the risk factors of hypertension in the check-up population to prevent and control hypertension precisely.Objective　To discuss the risk factors of different subtypes of hypertension among Urumqi population.Methods　6 699 residents aged between 35 and 74 years who participated in Xinjiang Universal Physical Examination were recruited from Shiyouxincun Street Community Health Center and Kaziwan Street Community Health Center in 2016.Multiple correspondence analysis was applied to search for the relationships of diabetes mellitus（DM），gender，age，body mass index，cigarette smoking，and alcohol drinking with hypertension subtypes.Results　Study showed that DM and obesity were closely related to isolated systolic hypertension（ISH） and systolic-diastolic hypertension（SDH）；cigarette smoking and alcohol drinking were closely related to isolated diastolic hypertension（IDH）．Further analysis stratified by gender and age showed that in 35-44-year-old group and 45-54-year-old group，DM and obesity were associated with ISH and SDH，and cigarette smoking and alcohol drinking were associated with IDH.But in 55-64-year-old and 65-74-year-old groups，no associations of cigarette smoking and alcohol drinking with hypertension subtypes were found.In females of different age groups，DM and obesity were found to have associations with ISH.Conclusion　Multiple correspondence analysis is a good technique for analyzing the check-up data.Associations of DM and obesity with ISH，and those of cigarette smoking and alcohol drinking with IDH in young and 35-54-year-old men should be concerned.

Effect of Dosage Optimization of Recombinant Human Tumor Necrosis Factor Receptor-Fc Fusion Protein for Injection on Patients with Ankylosing Spondylitis and Hip Joint Disease　

ZHANG Weihua，WANG Tingting，WANG Dongmei，WU Jianhong

2019, 22(16): 1973-1977. DOI: 10.12114/j.issn.1007-9572.2019.00.112

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Background　The high cost and obvious adverse reactions in long-term use of biological agents in patients with ankylosing spondylitis and hip joint disease are not conducive to improving treatment compliance；it is worth discussing how to solve related problems by reducing the dose.Objective　To investigate the influence of dosage optimization of recombinant human tumor necrosis factor receptor-Fc fusion protein（rhTNFR∶Fc） on severity of symptoms，laboratory indicators and safety of patients with ankylosing spondylitis and hip joint disease.Methods　A total of 136 patients with ankylosing spondylitis accompanied by hip joint lesions were divided into control group（n=68） and experimental group（n=68） according to the visit order.The routine dose and optimal dose of rhTNFR∶Fc were used respectively.The clinical remission rate，symptom severity index，imaging index，laboratory index and incidence of adverse drug reactions before and after treatment were compared between the two groups at the 24th week after treatment.Results　There were no significant differences in Assessment in Ankylosing Spondylitis（ASAS） 20，ASAS 40 and partial remission of ASAS between the two groups（P>0.05）.At the 24th week after treatment，the Ankylosing Spondylitis Disease Activity Score（ASDAS），Bath Ankylosing Spondylitis Disease Activity Index（BASDAI），Bath Ankylosing Spondylitis Function Index（BASFI），pain visual analogue score（VAS pain score），hip function score（Harris score），Spondyloarthritis Research Consortium of Canada（SPARCC） MR score，erythrocyte sedimentation rate（ESR） and C-reactive protein level were significantly better than those before treatment（P<0.05），and there was no significant difference in X-ray score of sacroiliac joint（P>0.05）；There was no significant difference in indicators between the two groups（P>0.05）.At the 24th week after treatment，the incidence of adverse drug reactions in the experimental group was lower than that in the control group（P<0.05）.Conclusion　The dosage optimization scheme of rhTNFR∶Fc has similar clinical efficacy with the conventional dosage scheme for patients with ankylosing spondylitis and hip joint lesions，but it is more conducive to reducing the risk of adverse reactions with better treatment safety.

Effects of Tongmaihuaban Decoction on Myocardial Perfusion Volume and Serum Levels of vWF and MMP-9 in Patients with Coronary Heart Disease　

WU Huiying，WU Jianli，YUAN Limei，ZHENG Mingchang

2019, 22(16): 1978-1982. DOI: 10.12114/j.issn.1007-9572.2019.00.128

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Background　The origin of coronary heart disease（CHD）is not completely clear，and it is treated mostly by standardized western pharmaceutical therapies such as antiplatelet drugs，beta-blockers，and nitrate preparations.Traditional Chinese medicine（TCM）classifies coronary heart disease as thoracic obstruction and true heart pain，and has a complete system of syndrome differentiation and treatment.Clinical evidence shows that，kidney deficiency，and phlegm and blood stasis play an important role in the occurrence and development of CHD.Objective　To observe the effects of Tongmaihuaban decoction on myocardial perfusion volume and serum levels of von willebrand factor（vWF）and matrixmetalloproteinase-9（MMP-9）in patients with CHD.Methods　A total of 196 patients with CHD were divided into conventional group（n=98）and Tongmaihuaban decoction group（n=98）by using a visit order from 2015 to 2017，treated with conventional therapy plus rosuvastatin（10 mg/time，once a day），conventional therapy plus rosuvastatin and Tongmaihuaban decoction（decocting 1 dose/2 times，200 ml/time），respectively.Both groups were treated continuously for 6 months.Treatment outcomes were evaluated by myocardial perfusion conditions（perfusion defect size and abnormal radiotracer distribution integrals showed by SPECT），serum levels of vWF and MMP-9，and oxidative stress indicators〔malondialdehyde（MDA），and superoxide dismutase（SOD）〕，and main TCM symptom scores.Self-controlled and intergroup comparisons were made in terms of changes in the aforementioned parameters from baseline to the end of a 6-month treatment.Results　After 6 months of treatment，the average perfusion defect size and abnormal radiotracer distribution integrals，serum levels of vWF，MMP-9 and MDA，and main TCM symptoms scores were decreased significantly in both groups compared with baseline（P<0.05），and they were much lower in Tongmaihuaban decoction group compared with conventional group（P<0.05）.Average serum SOD level increased significantly in both groups（P<0.05），and it was much higher in Tongmaihuaban decoction group than that in conventional group（P<0.05）.Conclusion　Conventional therapy plus rosuvastatin and Tongmaihuaban decoction，can effectively improve myocardial perfusion and vascular endothelial function，inhibit the formation of unstable atherosclerotic plaques，reduce oxidative stress response，improve TCM symptoms，and promote the recovery in CHD patients.

Effects of Sublingual Administration of Tongqiao Jiuxin Oil on the Quality of Life in Unstable Angina Pectoris Patients with Qi Stagnation and Blood Stasis Syndrome　

ZHUANG Yiyang，LU Yinyin，LI Rong，JIN Zheng，CHU Qingmin，LIANG Jinhuan

2019, 22(16): 1983-1989. DOI: 10.12114/j.issn.1007-9572.2019.00.137

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Background　Unstable angina pectoris（UAP）should be classified as "chest pain and heart pain" in traditional Chinese medicine.The pathogenesis of UAP is cardiopulmonary obstruction，and the nature of the disease is deficiency in origin but excess in superficiality.Tongqiao Jiuxin Oil，owning aromatic and warm ingredients，has a unique therapeutic effect on this disease via resuscitating and restoring consciousness，and regulating qi to alleviate pain.Objective　To explore the changes in clinical outcome and quality of life in response to sublingually administered Tongqiao Jiuxin Oil in UAP patients with qi stagnation and blood stasis syndrome.Methods　Totals of 240 UAP patients with qi stagnation and blood stasis syndrome were included in this study from May 2017 to April 2018.By use of a random number table，they were divided into control group（59 cases），oral group（60 cases），external use group（61 cases）and sublingual group（60 cases）．Oral Isosorbide Dinitrate Tablets were given to the control group，three times a day，for 7 consecutive days.Besides western treatment，Tongqiao Jiuxin Oil was given to the latter 3 groups via oral way，smearing on philtrum acupoint，and sublingual way，respectively，three times a day，for 7 consecutive days．Data concerning TCM symptoms score，heart fucnions evaluated by ECG，scores of SAQ，SF-12 and EQ-5D，and safety parameters before and after treatment，and adverse events during treatment were collected and analyzed statistically.Results　Post-treatment improvement in heart functions evaluated by ECG differed significantly across four groups（P<0.05）．Specifically，the improvement in sublingual group was significantly better than that of oral group and external use group（P<0.008 3），and was similar to that of the control group（P>0.008 3）．Pre- and post-treatment differences in TCM symptom score，SF-12 and EQ-5D were significantly different in four groups（P<0.05）．To be specific，post-treatment improvements in these three parameters in sublingual group were much better than those of other groups（P<0.05）．After treatment，there were significant differences in SAQ scores and their differences among the four groups in terms of physical activity limitation，stable state of angina pectoris and attack of angina pectoris（P<0.05）．Sublingual group was better than oral group and external use group（P<0.05）.Safety measurements of the all groups treated with Tongqiao Jiuxin Oil were found with no deterioration，and no adverse events occurred．Conclusion　Sublingual administration of Tongqiao Jiuxin Oil could achieve a positive efficacy with good safety，and significantly improve the overall quality of life in UAP patients with qi stagnation and blood stasis syndrome.

Development of a Family Doctor Performance Evaluation System Using the Delphi Method 　

LI Miqiong，WU Yumiao，ZHU Jie，ZHOU Chunyan，ZHI Yanhong，ZHU Shanzhu

2019, 22(16): 1989-1995. DOI: 10.12114/j.issn.1007-9572.2019.00.193

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Background　The development of a standardized system for the evaluation of the performance of family doctors is of great significance for strengthening the training of primary care providers.However，the evaluation methods for family doctors' training and performance in China are not comprehensive and systematic.Objective　To develop a comprehensive，scientific and systematic family doctor performance evaluation system.Methods　We developed the initial version of the Family Doctor Performance Evaluation System（FDPES）.Then，we conducted a two-round Delphi consultation in a judgment sample of 15 representatives invited from 15 medical institutions from October 2017 to November 2017 on the issues of the significance and integrity of the indicators in the initial version of the FDPES.According to the Delphi consultation results，we developed the final version of the FDPES after revising the initial version.Results　On average，the experts aged（51.7±9.9）years and had（28.4±11.2）years as a healthcare provider.The response rates of the two rounds of consultation were 100.0%.The authority coefficient of the experts was 0.93 and the Kendall's W for the primary and secondary indicators was 0.403（P<0.001），and 0.427（P<0.001），respectively.The final version of the FDPES consisted of three domains：（1） theoretical knowledge and clinical skills（including two primary indicators）；（2） professional capability（including 6 primary indicators and 30 secondary indicators）；（3） patient satisfaction（including 5 primary indicators）.Conclusion　The sampled experts for the Delphi consultation were highly representative，positive and authoritative.And the FDPES can comprehensively evaluate family doctors' levels of theoretical medical knowledge，clinical skills，clinical thought，professional capability，service quality，which can be used as an aid tool for family doctor performance evaluation.

Development of a Contracted Service Performance Evaluation System for Family Doctor Teams　

SHANG Xiaopeng，YANG Qing，QIU Yinwei，ZHAO Yanrong，WANG Wei，LIN Junfen，XU Xiaoping

2019, 22(16): 1996-1999. DOI: 10.12114/j.issn.1007-9572.2018.00.386

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Background　At present，the implementation of contracted family doctor services in China is an important measure for accelerating the development of the hierarchical medical system via strengthening the functions of primary care networks and promoting first consultation in primary care，by which the reform of the pharmaceutical and healthcare system can be deepened.However，there is a lack of scientific，reasonable and easy-to-use systems for the assessment of the contracted service performance of the family doctor team.Objective　To develop a contracted service performance evaluation system for family doctor teams，providing theoretical guidance for scientific evaluation of the contracted service performance of a family doctor team，and the building of a high-quality family doctor team.Methods　Delphi expert consultation method was used to establish the Contracted Service Performance Evaluation System for Family Doctor Teams（CSPESFDT）in August and September，2017．Analytic hierarchy process（AHP） was applied to determine the weight of the indicators of the CSPESFDT.Results　The response rates of the two rounds of expert consultation were 100.0%（21/21） and 90.5%（19/21），respectively.The mean coefficient of determination，familiarity coefficient and authority coefficient were 0.764 3，0.809 5，0.786 9 for the two rounds of consultation.The Kendall's W for the first and second consultations were 0.245（χ2=293.206，P<0.001），and 0.317（χ2=279.631，P<0.001），respectively.Finally，the CSPESFDT was developed，which consisted of 7 first-tier indicators，and 54 second-tier indicators with assigned weights.Conclusion　We successfully established the CSPESFDT using Delphi and AHP methods，which is contributive to the objective and scientific assessment of the contracted service performance of the family doctor team.

Recent Advances in Risk Factors for Delayed Thrombolysis in Ischemic Stroke　

LIU Qinqin，YANG Li，ZHAO Qiuli，ZHU Xuemei，CUI Dan，WU Yanni，ZHANG Jian，HUANG Shan，LI Huifang

2019, 22(16): 2000-2007. DOI: 10.12114/j.issn.1007-9572.2019.00.132

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Thrombolytic therapy is effective for acute ischemic stroke，if it is delivered within the specified time limit.Delayed access to healthcare is a major cause of inadequate or ineffective thrombolytic therapy.Many factors are associated with delayed treatment for stroke.We discussed them from patient-related，transportation and in-hospital aspects，aiming to provide a reference for related research.

Medical Treatment for Pain in Parkinson's Disease　

SHEN Yalian，CHENG Oumei

2019, 22(16): 2008-2014. DOI: 10.12114/j.issn.1007-9572.2019.00.241

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Pain is a common non-motor symptom of Parkinson's disease（PD），with its prevalence ranging from 40% to 85%.PD patients with pain are more likely to complicated with other non-motor symptoms，which cause decrease in patients' quality of life.This article summarized the clinical reports of drug therapy for patients with Parkinson's pain and its possible mechanism of action.The aim of this paper was to provide clinicians with reference information for the treatment of patients in pain with Parkinson's disease and put forward new goals to improve the treatment standard for the disease pain.

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