Chinese General Practice

Modern Home Care Medicine and Holistic Home Health Care　

WU Pin-hsien，CHEN Tao，YAO Nengliang

2021, 24(19): 2373-2378. DOI: 10.12114/j.issn.1007-9572.2021.00.205

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Centre for Health Management and Policy Research，School of Public Health，Cheeloo College of Medicine，Shandong University/NHC Key Lab of Health The aging society and medical advances have made home-based healthcare a worldwide focus. We firstly introduced the historical origin of home care medicine and home-based healthcare，then summarized the development of home care medicine in foreign countries，including education，research，and services. Following this，the concept，practice principles and scope of home-based healthcare were described. Besides that，the feasible team structure and the responsibilities of its members were expounded. Some issues needing to be noticed in developing home-based healthcare were also listed. Finally，the policies and some prototypes regarding home-based healthcare in China were introduced. We hope this article could serve the development of home-based healthcare in China.

Home Health Care Delivery Models in China：an Exploratory Comparative Study　

BAI Meng，GE Haotong，YAO Nengliang，CHEN Tao，WU Pin-hsien

2021, 24(19): 2379-2384. DOI: 10.12114/j.issn.1007-9572.2021.00.229

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Centre for Health Management and Policy Research，School of Public Health，Cheeloo College of Medicine，Shandong University/NHC Key Lab of Health BAI Meng and GE Haotong are co-first authors To address the challenges of aging，the exploration of home-based healthcare delivery models has been carried out in various parts of China. Through wide investigation and intensive interviews，we found three typical home-based healthcare delivery models that are in an exploratory stage：home-based sickbed services developed and delivered by the community health center using the contacting form of family doctor system promoted by the government，home-based medical services delivered by public hospitals improving their operation and management forms via integrating healthcare resources from the hospital and other providers，and individualized home-based healthcare provided by private hospitals according to the specific needs of various populations. We found the same challenges faced by these models after a comparatively analysis：incomplete laws related to home-based healthcare，lack of professional trainings for workers providing home-based healthcare，and non-coverage of most home-based healthcare services.

Implementation，Outcome，and Evaluation of Rural Primary Care Physicians Training Programs in Foreign Countries：a Systematic Review　

SHEN Ying，HUANG Xing，KONG Yan，ZHAO Yue，ZHANG Xin，ZUO Yanli

2021, 24(19): 2385-2393. DOI: 10.12114/j.issn.1007-9572.2021.00.196

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Background　The rural-oriented tuition-waived medical education（RTME） program has been launched in China since 2010，aiming to provide rural areas with more primary care physicians with medical undergraduate education to address the shortage of rural physicians. We systematically reviewed the implementation，outcome and assessment of similar medical education programs among foreign countries，offering theoretical insights into the evaluation and improvement of RTME programs in China. Objective　To understand the implementation，outcome，and assessment of rural physician training programs in foreign countries. Methods　The databases of Ovid MEDLINE，PubMed，Cochrane Library and Google Scholar were electronically searched from February to July 2015 for English language articles published between 2000-01-01 and 2019-01-01 regarding the implementation，outcome and assessment of medical training programs for rural primary care physicians and residents in foreign countries. The search terms used were as follows："as Googlescholar " "medical education+medical undergraduate student" "medical college education" "medical student" "standardized residency programs" "medical specialty+human resource" "rural area" "rural primary healthcare service" "physician practice location" "rural primary care physician" "rural primary care physician training" "rural medical internship"，and "rural clinical clerkship". Results　This study eventually included 53 articles coming from six countries comprising the US，Canada，Australia，Japan，Thailand and South Africa，with 20 medical college programs and 6 residency programs described. Key components consisting of specific enrollment strategies，clinical curriculum highlighting both rural medicine and general practice，mentorship of family physicians practicing in rural areas，and rural clinical practice bases were shared amid the 26 programs. Compared to graduates of non-rural training programs，graduates of rural training programs exhibited significantly higher rates of choosing family medicine as practice specialty，practicing in rural areas，and retaining in rural areas for a long time. No prominent differences were detected between both types of graduates regarding mean scores as well as passing rate of the national medical licensing examination. Long-term rural clinical clerkship，specific enrollment strategies favoring rural background，and mentorship by family physicians practicing in rural areas were key factors associated with ultimate outcomes of those programs. Conclusion　Medical education is an effective solution to address the shortage of rural primary care physicians. Enrollment strategies，clinical curriculum development，mentorship，as well as assessments from these foreign rural primary care physician training programs may provide helpful suggestions for RTME programs in China.

Recent Advances in Position-specific Competencies Evaluation System Development for Chinese General Practitioners

WEI Yun，WANG Feiyue，WANG Meirong，PAN Zhaolu，JIN Guanghui，LU Xiaoqin

2021, 24(19): 2394-2400. DOI: 10.12114/j.issn.1007-9572.2021.00.103

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Background　The position-specific competencies evaluation for general practitioners（GPs），the gatekeepers of residents' health，has gradually obtained the attention of scholars in general practice. Objective　To understand recent advances in the development of position-specific competencies evaluation system for Chinese GPs，to provide a basis for scientific evaluation of their position-specific competencies. Methods　From September 15 to 25，2020，we searched studies on the development of position-specific competencies evaluation system for Chinese GPs in databases of CNKI，CQVIP and Wanfang. Using advanced retrieval to construct retrieval strategy "（post competency+competency model+competency） * （general practitioner+general practitioner+family doctor+primary medical and health personnel）*（evaluation+evaluation+index+tool）"，with "Chinese abstract" or "title" as the search criteria，the matching method is "accurate matching"，and the retrieval time limit is "publication time is unlimited-up to September 2020". Bibliographical and content analyses were used to analyze the eligible studies. Results　A total of 763 studies were found and 31 of them were finally included，including 27 journal articles in Chinese，and four dissertations. A total of nine methods were used for developing the system，and the most frequently used was literature research〔71.0%（22/31）〕，followed by qualitative interview〔45.2%（14/31）〕，questionnaire survey〔45.2%（14/31）〕，and Delphi method〔45.2%（14/31）〕. The WONCA tree was the most commonly used framework，22.6%（7/31） of the studies used it for developing items. The numbers of items of the systems are various，ranging from 14 to 113. Seven studies reported their developed systems containing more than 40 items. These systems are comprehensive，generally meeting current requirements for evaluating Chinese GPs' position-specific competencies. Conclusion　Although there have been many academic studies on the development of position-specific competency evaluation systems for Chinese GPs，little was reported about application of these tools. Further research can focus on the practical use and improvement of these systems.

The Standardized Training Teaching Mode in Standardized Training of Domestic General Practice Residents and Its Application Effect　

ZHAN Jingyan，LOU Jingqiu，WANG Shaokun，CHEN Wei，SONG Shaojie

2021, 24(19): 2401-2407. DOI: 10.12114/j.issn.1007-9572.2021.00.201

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Background　There are many kinds of standardized training teaching models for domestic general practitioners. Only by being familiar with the characteristics of each teaching mode can we better comprehensively use these teaching modes. Objective　To analyze the teaching mode，application status and effect evaluation of standardized training for general resident physicians in our country（general resident training）. Methods　In January 2020，the literatures about the teaching mode of national standardized training of general practitioners collected from Wanfang database，China National Knowledge Infrastructure（CNKI），and Weipu database from January 1，2010 to January 31，2017 were analyzed. The key words were "全科医学" "全科住院医师规范化培训" "全科规培" "全科规范化培训" and "教学模式". Results　A total of 75 articles from 53 domestic hospitals were selected for the study. The common problem discussed in the literature is the analysis of the application effect of the existing teaching model of general subjects in the residential training of general subjects. Compared with the traditional teaching model，the new teaching model is in the theoretical knowledge training，clinical practice ability training，and training of students. There are significant advantages in humanities education and satisfaction. The teaching models related to general subjects mainly include 29 papers related to problem-based learning（PBL） teaching model，17 papers related to out-patient teaching model，11 papers related to case-based learning（CBL） teaching model，and 9 papers related to tutor group teaching modes. The rest are 3 papers related to scenario simulation teaching mode，team-based（TBL）learning and teaching mode，standardized patient（SP） teaching mode，3 papers related to Balint group teaching mode，3 papers related to supervised teaching mode，and 3 papers related to online combined with offline teaching mode based on "Internet +" thinking. And one paper related to each teaching modes including medical and nursing joint teaching mode，seminar-style teaching mode，"flipped classroom" teaching mode，mind map teaching mode，specialist-general practice joint teaching rounds（CSGR） mode，whole course managementteaching mode，precision teaching teaching mode，formative evaluationteaching mode，student lecture mode，inquiry there is one paper for each of the card medicine and demand-oriented teaching mode. PBL，CBL，TBL，situational simulation teaching，mentor group，formative evaluation teaching mode is suitable for improving students' comprehensive ability；flipped classroom，student lecture，mind map teaching mode focuses on the improvement of students' theoretical knowledge level；SP evaluate and train the teaching model of trainees focus on improving the basic skills of the trainees' reception and physical examination；CSGR and whole-course management，evidence-based medicine and seminar-style teaching models are suitable for improving trainees' independent thinking ability；the Balint group teaching model focuses on improving trainees' medical skills. The online and offline hybrid teaching model under the "Internet+" thinking is suitable for the period of the epidemic. The vertically hierarchical outpatient teaching model，GP-IP general practice teaching model and supervised outpatient clinic can improve the training quality of general practice. Conclusion　Different teaching modes are suitable for the cultivation of students' different abilities. According to the general residential training syllabus，the key to improve the quality of general residential training is to formulate precise teaching goals for general residential training. Each rotating department selects a new teaching mode or integrates different teaching modes based on its own actual conditions.

Building a World-class Integrated High-quality Healthcare System with Chinese Features: an Analysis of the Experience of Shenzhen Luohu Hospital Group　

GONG Fangfang，SUN Xizhuo，LI Ya'nan

2021, 24(19): 2408-2411. DOI: 10.12114/j.issn.1007-9572.2021.00.178

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Shenzhen，as China's pioneering demonstration zone for reform and opening-up，has been placed with new hope in the new era，namely to build an international first-class integrated high-quality healthcare system. However，there is a lack of relevant standards. After reviewing the integration of healthcare resources worldwide，we selected and detailedly analyzed the performance of Shenzhen Luohu Hospital Group，namely Luohu Model，as a regional representative for the establishment of integrated high-quality healthcare system in China. The group has taken four kinds of actions to implement the task：establishing a compact medical consortium with only one legal representative，promoting the allocation of high-quality healthcare resources to primary care，recasting the delivery of whole life healthcare with priority given to prevention，facilitating the reform of methods of payment from the health insurance based on outcomes. It is hoped that this group's experience could offer insights to the development of a national-level integrated high-quality healthcare system with Chinese characteristics.

Effectiveness of a Mode Used in the Delivery of Preventive and Medical Services by Family Doctors Using a Grid System　

ZHONG Yu，LIU Luxia

2021, 24(19): 2412-2417. DOI: 10.12114/j.issn.1007-9572.2021.00.225

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Background　Recently，the implementation of family doctor services provided by primary care has achieved some improvements，but there are still poor areas in family doctors' delivery of preventive and medical services，such as integrating the local resources，keep appointments，and collaborative services，so the priority current is to improve the quality and efficiency of community health services. The "12345" mode，a new contracting mode developed by Yuzhong District Daxigou Subdistrict Community Health Center used in the delivery of family services has formed a good pattern of integrating resources，co-contracting，service deepening，and joint management. Objective　To introduce and analyze the effectiveness of a mode used in the delivery of preventive and medical services using a grid system by family doctors in Yuzhong District Daxigou Subdistrict Community Health Center，Chongqing. Methods　Data regarding family services implemented from October 2017 to September 2019 were collected from the family doctor studio established by Yuzhong District Daxigou Subdistrict Community Health Center（hereinafter referred to as the Center），Chongqing，which were provided by the studio mainly，in coordination with other departments organized by the subdistrict office，with Big Health Care Idea as the service concept，centering on contracted services，mainly involving a grid system，two types of collaborative system，three types of publicity and cooperation，four co-management paths，and five detailed lists of services（abbreviated as the "12345" mode）. Results　As of September 2019，the contracting rate of the studio〔28.08%（5 086/18 109）〕 was significantly higher than that of the Center〔22.98%（14 352/62 453）〕. The renewal rate of the studio reached 91.41%（4 649/5 086），and 84.67%（370/437） of the rescinding group belonged to those moving from Yuzhong District due to relocation. In the appointment services for contracted people，the proportion of outpatient services，municipal examination，and home visit services increased by 159.07%（2 744/1 725），12.41%（149/1 201），and 21.92%（260/1 186），respectively，while the proportion of referrals and expert services decreased by 48.36%（118/244） and 24.55%（108/440），respectively. Compared to 2018，the standardized management rate and control rate of hypertension and diabetes in 2019 were all significantly higher（P<0.05）. And the ratio of comprehensive evaluation，expert evaluation and appointment examination for hypertension and diabetes in 2019 were significantly higher（P<0.05）. The studio achieved higher patient satisfaction than non-family doctor studios either in 2018（87.03% vs 42.91%） or in 2019（92.5% vs 57.5%）（P<0.05）. Conclusion　The "12345" mode，a new contracting mode developed by the Center used in the delivery of family services has improved residents' compliance，sense of gain and satisfaction，achieving good results.

Applicability of the SRHMS V1.0 in the Rural Elderly：an Analysis of 2 048 Cases　

GAO Chuqun，ZHANG Hechuan，LUO Songlan，ZHANG Yajing，GUO Liangji，ZHANG Lili

2021, 24(19): 2418-2422. DOI: 10.12114/j.issn.1007-9572.2021.00.218

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Background　To achieve healthy aging along with global aging，integrated geriatric care using person-centered approach has been recognized to be a useful way to satisfy older people's health needs as an international consensus. It is particularly important and urgent to develop a tool to assess the physical，psychological，social，spiritual and environmental health of the elderly in rural China. Objective　To evaluate the applicability of the SRHMS V1.0 in rural elderly people. Methods　From October 2018 to May 2019，2 048 individuals aged 60 or over were selected from Yunnan's rural areas by use of multistage stratified sampling，and received a household survey using a Demographic Questionnaire and the SRHMS V1.0. The reliability and validity of the SRHMS V1.0 were analyzed，and the SRHMS V1.0 normative scores for Chinese rural elderly people in the age group were determined. Results　The survey obtained a response rate of 85.33%. The mean total score and the mean scores of physical，psychological and social health subscales of the SRHMS V1.0 were （63.63±13.69），（64.72±16.94），（62.59±15.34） and （50.71±13.04），respectively. The Cronbach's α of the SRHMS V1.0 was 0.941，and that for the physical，psychological and social health subscales were 0.877，0.885 and 0.875，respectively. With the exception of items 4，5 and 7，and physical symptoms/organ function subscale，item 27 and psychological symptoms/negative emotion subscale with a value of r≤0.600，all the items and corresponding subscales had a value of r≥ 0.600（P<0.001）. The results of confirmatory factor analysis showed that the modified CFA model with χ2/df=5.509，RMSEA=0.047，NFI=0.929，IFI=0.941，TLI=0.933，CFI=0.941，showing an excellent goodness for fit. The The SRHMS V1.0 normative scores for rural elderly people were determined as：very poor［0，49.93），poor［49.93，56.78），fair［56.78，70.48），good ［70.48，77.32），very good ［77.32，100］．Conclusion　The SRHMS V1.0 has good reliability and validity in assessing the health status among rural elderly people，which may be applied and popularized as an assistant tool by general practitioners to perform comprehensive health assessment and deliver community interventions.

Risk Assessment of Common Chronic Non-communicable Diseases in Medical and Teaching Professionals from a District of Beijing：an Analysis of 4 916 Cases　

LIU Feng，XIA Guobao1，MA Guanhui，YANG Weihao，LI Mingliang，ZHU Chao，ZHOU Ying，ZHANG Jingbo

2021, 24(19): 2423-2427. DOI: 10.12114/j.issn.1007-9572.2021.00.219

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Background　In 2019，besides a physical examination，a risk assessment of common chronic diseases was carried out for the occupational population mainly aged 18-70 from a functional community in a district of Beijing. The high-risk results of common chronic diseases in representative medical and teaching professionals were compared. Objective　To examine the chronic disease risk in teaching professionals according to age，gender and occupation，and that in medical professionals according to age，gender，occupation and hospital level. Methods　Participants were 4 916 community-dwelling teaching and medical professionals from a district of Beijing who underwent a physical examination during January to December 2019. Data were collected via a health questionnaire survey，reviewing the physical examination，and laboratory examinations，and were analyzed for evaluating the 3-5-year risks of metabolic syndrome，hypertension，diabetes，stroke，and coronary heart disease. Results　Among the 4 916 samples，the 3-5-year risks of 5 chronic non-communicable diseases were predicted to increase fluctuatedly with age. Men had higher rate of having high risks of metabolic syndrome，coronary heart disease，diabetes，and stroke than women（P<0.05）. Occupation-based analysis found that medical professionals had higher rate of having a high risk of metabolic syndrome than teaching professionals（P<0.05）. Hospital level-based analysis revealed that medical professionals from community hospitals had higher rate of having a high risk of metabolic syndrome than those from grade A tertiary hospitals （P<0.05）. Compared to female teaching professionals，male teaching professionals had higher rate of having a high risk of metabolic syndrome，coronary heart disease，diabetes，or stroke（P<0.05），and a similar rate of having a high risk of hypertension. And similar status was found between male and female medical professionals. In addition，male teaching professionals had a higher rate of having a high risk of hypertension than male medical professionals（P<0.05）. Female medical professionals had a higher rate of having a high risk of metabolic syndrome than female teaching professionals（P<0.05）. Conclusion　The 3-5-year risks of these 5 chronic non-communicable diseases were predicted to increase fluctuatedly with age. And the risks were significantly related to gender. A priority should be given to the risk of metabolic syndrome in medical professionals.

Accessibility and Comprehensiveness of Contracted Family Doctor Services in Rural Areas Using Perceived Quality Framework　

HAN Xiangru，QIN Caixin，WU Yi，TIAN Lanlan，WANG Yiting，QIAN Dongfu

2021, 24(19): 2428-2434. DOI: 10.12114/j.issn.1007-9572.2021.00.181

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Background　China has launched family doctor services as a key action to improve the allocation of primary care resources and quality of healthcare services. Currently，the rate of contracting is increasing stably，but there is a lack of systematic and authoritative evaluation of the accessibility and comprehensiveness of such services，which is significantly associated with further improvement of the implementation and quality of the services. Objective　To study the accessibility and comprehensiveness of contracted rural family doctor services for chronic disease patients and associated factors. Methods　In July 2019，1 814 elderly patients with chronic diseases were selected by typical sampling and multi-stage stratified sampling in Jiangsu Province to attend a questionnaire survey for investigating their essential socio-demographic characteristics，quality assessment of contracted family doctor services，and health behaviors. This paper mainly analyzes the accessibility and comprehensive level of family doctors in rural areas. Results　A total of 1 728（95.26%） cases were included for analysis，of whom 1 510（87.38%） rated the accessibility of contracted family doctor services relatively high，and 1 497（86.63%） had a relatively high level perception of comprehensiveness of the services. The Logistic regression analysis indicated that patients' geographical location，medication option，and doctors' fulfillment of service commitments were associated with patients' perception of comprehensiveness of the services（P<0.05）. Patients' geographical location，medication option，and doctors' fulfillment of service commitments were associated with patients' perception of accessibility of the services（P<0.05）. Conclusion　On the whole，the levels of accessibility and comprehensiveness of contracted rural family services were relatively high，but the perceived evaluation level of psychological services in comprehensiveness dimension was low. Furthermore，those who lived in northern Jiangsu，uesd medication prescribed by doctors working at a village clinic，and received services from doctors with good fulfillment of service commitments rated the comprehensiveness and accessibility of contracted family doctor services relatively high. Our analysis suggested that the local government should improve the accessibility and comprehensiveness of the services by improving contracting modes，service implementation and accessibility of essential medicines according to local associated factors.

Technicality of Contracted Family Doctor Services in Rural Areas Using Perceived Quality Framework　

TIAN Lanlan1，HAN Xiangru1，WU Yi1，QIN Caixin1，LIU Rugang1，QIAN Dongfu1，2*

2021, 24(19): 2435-2439. DOI: 10.12114/j.issn.1007-9572.2021.00.180

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Background　The elderly and chronic disease patients have been included in the key contracting population. Family doctors play an ever-growing role in improving their quality of life via enhancing disease management.However，there is a lack of technicality analyses of contracted services by them. Objective　To study the technicality and influencing factors of contracted family doctor services provided by rural family doctors for patients with chronic diseases，providing a basis for improving the technicality level of such services. Methods　In July 2019，a combination of typical sampling and stratified cluster sampling was used for selecting contracted rural elderly chronic disease patients from southern，central and northern Jiangsu to participate in a questionnaire survey involving socio-demographic characteristics，quality evaluation of contracted services，healthy behaviors. Multivariate Logistic regression analysis was used to explore the influencing factors of patients' perception of technicality level of the services. This paper mainly analyzes the perception of rural elderly patients with chronic diseases on the technical quality of family doctor contract service. Results　Of all the 1 728 contracted patients，316（18.29%）gave a lower overall perception score for the technical dimensions. Diagnosis and treatment technology level， medication service and disease control development were the three technical dimensions，and the lower ones accounted for 17.19%（297 cases），13.31%（230 cases） and 10.82%（187 cases） respectively. Logistic regression analysis showed that sex，geographical location，whether preferring the care for a minor illness delivered by a family doctor，and the main source of medication schemes were associated with patients' perception of technicality level of the services（P<0.05）. Conclusion　In short，the overall technicality level of contracted rural family doctor services，especially the diagnostic and treatment level of family doctors，should be improved. Women，southern Jiangsu，using a medication scheme prescribed by doctors working at a village clinic，and always seeing a family doctor for a minor illness may be associated with higher perception of technicality level of contracted family doctor services. To further improve the technicality of the services，we put forward the following suggestions：priority should be given to central and northern Jiangsu，with a focus on improving the diagnostic and treatment level of family doctors；enhancing the intergovernmental transfer system；innovating the contracting forms；strengthening the future family doctor workforce.

Continuity Evaluation of Contracted Family Doctor Services in Rural Areas Using Perceived Quality Framework　

QIAO Jingyi，CHEN Wangxinyue，YANG Junjie，LIN Zhenping，QIAN Dongfu

2021, 24(19): 2440-2444. DOI: 10.12114/j.issn.1007-9572.2021.00.182

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Background　In China，the implementation of contracted family doctor services is an important measure to improve the allocation of primary health care resources and quality of health care services. Although the overall contracting rate and quality of contracted services are steadily improving，there is still a lack of systematic and comprehensive tracking，collection，and studies on the continuity of such services. Objective　To investigate the continuity and influencing factors of diagnostic and treatment services provided by rural family doctors for elderly patients with chronic diseases. Methods　Typical sampling and stratified cluster sampling were used to select contracted patients from three representative counties（districts） sampled from central，southern and northern Jiangsu，China（one from each area） to attend a questionnaire survey for investigating their essential socio-demographic characteristics，quality assessment of contracted family doctor services，and health behaviors. This paper mainly analyzes the perception of rural elderly patients with chronic diseases on the service continuity. Results　A total of 1 814 cases attended the survey，1 728 of them returned responsive questionnaires，gaining a response rate of 95.26%. It was found that respondents' mean perceived evaluation score on several questions of horizontal continuity was （4.58±0.519），while that on several questions of vertical continuity was（3.48±0.817）. Seven hundred（40.50%） of the respondents gave a high evaluation of service continuity. The Logistic regression analysis showed that contracted patients' geographical location，source of medication option，evaluation of follow-up services，and guidance for healthy behaviors were the main factors affecting their perceived evaluation of continuity of contracted family doctor services. Conclusion　The continuity of family doctor services still needs to be improved. It is recommended to strengthen doctor-patient communication，establish a new delivery model of primary health care services，and improve the contracting system.

Professional Identity of Family Doctor Team Members and Influencing Factors：a Survey　

HOU Hao，DAI Ronghui，WU Jing，MIAO Chunxia，GAO Xiuyin

2021, 24(19): 2445-2451. DOI: 10.12114/j.issn.1007-9572.2021.00.211

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Background　The family doctor system is a new delivery model for community medical services. Compared to community doctors，family doctor team members shoulder more workload，namely，delivering more types of services for people from larger areas of service coverage，which may be a reason for high turnover prevalence among family doctor team members recently. Studies at home and abroad have proved that the enhancement of professional identity plays an important role in strengthening team building，alleviating job burnout and reducing turnover intention. Objective　To investigate the professional identity of family doctor team members and associated factors via a survey from Xuzhou，providing a scientific basis for promoting the professional development and team building of family doctors. Methods　From May to October 2017，all the members（n=700） of family doctor teams in 36 community health centers offering family doctor services in Xuzhou were recruited by typical sampling and participated in a survey for investigating the status of professional identity using a self-compiled questionnaire. Stepwise multiple linear regression analysis was used to explore the influencing factors of the professional identity. Results　The total score of professional identity for the members was（71.57±9.01） points. And the average score of the four dimensions of professional sense of belonging，professional behavioral tendency，professional values and professional self-awareness for them were（4.53±0.67），（4.45±0.64），（4.27±0.59），and （3.82±0.77） points，respectively. Stepwise multiple linear regression analysis demonstrated that educational background，monthly income，marital status，work preference，family-work relationship，career planning，and work pressurewere factors affecting the professional identity（P<0.05）. Conclusion　The professional identity of Xuzhou family doctor team members was rated as good，but there is still room for improvement，especially in the aspect of professional self-awareness. To enhance the professional identity of this group，it is recommended to improve related governmental policy supports and related social supports，as well as ideological education for general medical college students.

Association of Job Burnout and Presenteeism among Family Doctor Team Members in Chongqing　

HE Lingling，PU Chuan，HUANG Liping，BAI Junqi，LIU Qian，HUANG Rui，HE Yuxin

2021, 24(19): 2452-2458. DOI: 10.12114/j.issn.1007-9572.2021.00.230

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Background　Family doctor team members are more likely to be overworked recently due to increased pressure of life and work，which may increase the prevalence of presenteeism，negatively impacting patients' health and safety，and hindering the development of family doctor services. The prevention and control of job burnout is the key to reducing high prevalence of presenteeism. Objective　To analyze the relationship between job burnout and presenteeism in family doctor team members in Chongqing. Methods　A survey was carried out with a cluster sample of members of 593 family doctor teams randomly selected from all the family doctor teams（n=8 171） in Chongqing from May to July，2020. The General Information Questionnaire（developed by us），Chinese version of Maslach Burnout Inventory-General Survey（MBI-GS-C），and Chinese version of Stanford Presenteeism Scale-6 were used for the survey，and the collected data were analyzed. Results　Altogether，13 433 of the 14 000 members（95.95%） effectively responded to the survey. The mean scores for MBI-GS-C，emotional exhaustion，depersonalization，and personal accomplishment of the respondents were （2.55±1.17），（2.48±1.49），（1.89±1.53），and（2.47±1.64） points，respectively. The job burnout prevalence was 78.93%（10 603/13 433），and presenteeism prevalence was 46.30%（6 219/13 433）. Presenteeism prevalence among family doctor team members significantly varied by gender，age，marital status，mean monthly income，highest educational attainment，affiliation，mean commute time，main reasons for choosing the job，prevalence of emotional exhaustion，depersonalization，personal accomplishment and job burnout（P<0.05）. Emotional exhaustion，depersonalization and low personal accomplishment were major influencing factors of presenteeism（P<0.01）. After controlling for demographic characteristics and occupational factors，Logistic regression analysis showed that job burnout was still associated with presenteeism，and the OR value remained relatively stable. Conclusion　Job burnout prevalence may be closely associated with presenteeism prevalence in family doctor team members，which may increase with the increase of presenteeism prevalence. And this association will not be related to demographic characteristics，socio-economic factors and occupational factors.

Supplier's Perspective of the Status and Problems in Community-based Delivery of Integrated Medical and Nursing Care：a Qualitative Study　

LYU Xinrui，WANG Ziyao，QIN Wei，ZHANG Wei，CHEN Xiaojun，PENG Jingjing，LIU Baohua

2021, 24(19): 2459-2464. DOI: 10.12114/j.issn.1007-9572.2021.00.189

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Background　China is facing a great challenge brought by population aging. In addition to the current increasing disease burden of the elderly，the weakening of the elderly care capacity of modern families，and the imbalance of supply and demand in elderly care institutions，the provision of integrated medical and nursing care has become an inevitable option to satisfy the healthcare needs of older adults. Objective　To investigate the status of integrated medical and nursing care delivered by community health centers（CHCs），and analyze the problems，providing feasible suggestions for better development of elderly care services. Methods　Personal interviews were conducted between September and November，2019 with mangers or workers engaging in integrated medical and nursing care from 40 CHCs in Beijing's Chaoyang District regarding their demographics，perceptions of overall status of workers in the CHCs，awareness of integrated medical and nursing care，evaluation of integrated medical and nursing care delivered by the CHCs，and the problems in the delivery. The interview data were analyzed by Colaizzi's seven-step method. Results　The response rate of the interviews was 97.5%. Seven themes were summarized：The number of nurses in the CHC was insufficient to meet the service needs. The rate of physicians and nurses with geriatric medicine training was low，and varied significantly among the CHCs. The construction of rehabilitation facilities was imbalanced among the CHCs. The perceptions of integrated medical and nursing care differed across the managers of CHCs. The proportion of elderly care services carried out was relatively low. There was a phenomenon of multiple management of integrated medical and nursing care. The relatively high risks for the delivery of integrated medical and nursing care were insufficient number of workers，policy support and fund as well as inappropriate practice. Conclusion　To promote the delivery of community-based integrated medical and nursing care，it is suggested to improve the training models and incentives for talents in geriatric medicine，modify relevant policies，laws and regulations，improve the pilot implementation of insurance reimbursement system for long-term nursing，guide the input of multiple funds，and enrich service items of integrated medical and nursing care.

Unmet Needs of Activities of Daily Living and Influencing Factors in the Elderly：a Survey from Medical and Nursing Care Institutions　

WANG Binding，LIU Gang，ZHENG Xinlie，WANG Hang，ZHANG Baolu

2021, 24(19): 2465-2471. DOI: 10.12114/j.issn.1007-9572.2021.00.131

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Background　 In China，rapid aging has brought severe challenges. The increasing elderly care needs of growing older people may not be met although the number of medical and nursing care institutions is increasing. And their unmet health needs may lead to increased rates of hospitalization，readmission，rescue and even mortality. Objective　To explore the unmet needs of activities of daily living and influencing factors in older adults from medical and nursing care institutions. Methods　 From June to December in 2019，Participants for a survey were selected from 53 medical and nursing care institutions，Sichuan Province，by use of convenience sampling，including older adults surveyed using a self-developed demographic information questionnaire（for older adults），the Functional Activities Questionnaire（FAQ），the Barthel Index（BI），and the Unmet Needs Assessment Scale（developed by us in accordance with the contents of FAQ and BI），and their major caregivers surveyed using a self-developed demographic information questionnaire（for older adults' caregivers）. Factors associated with older adults' unmet needs were screened using univariate analysis，and were determined using logistic regression analysis. Results　A total of 1 325 older adults with disabilities and 442 caregivers were finally included. In the older adults，the prevalence of having at least one unmet need was 97.36%；the prevalence of having 5 unmet needs was 50%，and the most needed was walking on flat ground，followed by traveling，dressing up，engaging in daily recreational activities，and socializing. Logistic regression analysis revealed that the possibility of having unmet needs of these older adults increased with the prolongation of disability and increase of FAQ score，and age of the caregiver，but decreased with their increased level of education and monthly income，as well as increased monthly income of the caregiver（P<0.05）. Conclusion　 In medical and nursing care institutions in Sichuan Province，the rate of having unmet needs of activities of daily living in older adults with disabilities was high and affected by many factors. To satisfy the needs of these people，it is suggested to improve the scientific management of the institutions，with special attention given to humanistic care，enhance the care level of caregivers via improving their comprehensive qualities，increase the financial aid from the government，encourage social donation and in-depth research on elderly care insurance system.

Developing Community Pediatrics in China：Necessity，Feasibility，and Recommendations Derived from the US Training System for Community Pediatricians　

CHEN Chen，PENG Qihua，SHI Jianwei，HUANG Jiaoling，ZHOU Liang，LIU Qian，YANG Yan，CHEN Ning，LIU Xiang，YU Wenya

2021, 24(19): 2472-2476. DOI: 10.12114/j.issn.1007-9572.2021.00.188

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Considering the increasing demand for children's health care，including preventive care，and the prominent difficulty of caring children with special health care needs，the development of community pediatrics is the key to dealing with these problems. We discussed the feasibility of developing community pediatrics in China from aspects of national political direction，actual demand for community pediatric care in care needers，and expected development of community pediatric care of the care providers. Moreover，seeing that the US experience of developing community pediatrics is quite quotable，after reviewing the US development of training system for community pediatricians，we put forward suggestions on developing community pediatrics in China，including the training patterns，goals，contents and settings as well as types of educators.

Demand for Pediatric Care Based on Analyzing Pediatric Disease Spectrum in the Community：Data from Shanghai's Chongming District　

ZHU Dehao，SHI Jianwei，HUANG Jiaoling，ZHOU Liang，YANG Yan，CHEN Ning，LIU Qian，YU Wenya

2021, 24(19): 2477-2483. DOI: 10.12114/j.issn.1007-9572.2021.00.213

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Background　Identifying the characteristics of disease spectrum will help to triage patients more rationally，promoting the sound development of different types of hospitals. Objective　To understand the percentage and features of diseases in the pediatric disease spectrum in healthcare institutions in Shanghai's Chongming District，providing scientific basis for rationally guiding the tiered diagnosis and treatment of pediatric diseases and community pediatric care development in this district. Methods　Data about diseases suffered by children and adolescents（0-18 years old） were collected from the hospital health information system of all hospitals in Chongming District from 2016 to 2018. The diseases were analyzed，and ranked by their percentage of the spectrum. Changes in the disease spectrum were analyzed by year，age group，and level of hospitals. Results　In these three years，the outpatient and inpatient visits in the 21 hospitals in Chongming District numbered 410 711，and 15 665，respectively. Among all diseases，the first and third major diseases in each year were respiratory diseases，and digestive diseases，respectively. In diseases treated with outpatient care，skin and subcutaneous tissue diseases accounted for a large proportion，ranking in the top third. Of the diseases treated with inpatient care，the top third was diseased conditions of perinatal origin，and the sufferers were mainly aged 0-5 years. The visits in the tertiary hospitals were much more than those in community hospitals. Moreover，the visits showed a year-to-year growth in tertiary hospitals while demonstrated a year-to-year decline in community hospitals. Conclusion　The spectrum of pediatric diseases in Chongming District is not significantly different from that in other regions. In the prevention and treatment of such diseases，attention should be paid to the local special conditions，such as high-incidence skin and subcutaneous tissue diseases and diseased conditions of perinatal origin in children aged 0-5 years. Furthermore，to achieve tiered diagnosis and treatment for pediatric diseases in this district，it is urgent to develop community pediatric care to improve the diagnosis and treatment level of common pediatric diseases in community hospitals.

Evaluation of Pediatric Clinical Competency Training Program for Community General Practitioners and Its Impact on the Operation of Community Pediatric Clinic　

LOU Rongrong，CHEN Liang，LI Qiang，ZHOU Jing，ZHU Shanzhu

2021, 24(19): 2484-2488. DOI: 10.12114/j.issn.1007-9572.2021.00.231

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Background　In China，the contradiction between supply and demand of pediatric services is increasingly prominent，and the development of general pediatrics may be the most likely breakthrough to alleviate the shortage of pediatric resources. In Jiading District，community hospitals were incapable to deliver pediatrics services to satisfy residents' needs. To rationally allocate pediatrics resources，and address the issue of too many resources used by common pediatric illnesses and frequently-occurring pediatric diseases in children's hospitals，Jiading District Health and Family Planning Commission（now known as Jiading District Health Commission） has initiated Shanghai's Jiading pediatric clinical competency training program for general practitioners（GPs） in 2017. Objective　To investigate the influence of the implementation of Shanghai's Jiading pediatric clinical competency training program for GPs for the first time on the operation of pediatric clinic in 13 community health centers（CHCs） in this district. Methods　From January to March 2018，we conducted a survey with 14 GPs with an experience of attending Shanghai's Jiading pediatric clinical competency training program for GPs and other GPs without from 13 CHCs. A self-designed 49-item questionnaire was used to collect the general personal data，status of the operation of community pediatric clinic and suggestions for pediatric training. Results　All the 207 cases participating in the survey handed in responsive questionnaires including 14 trained GPs and 193 untrained GPs. Among the trained GPs，50.0%（7/14） reported that they were capable to deliver pediatric outpatient services，78.6%（11/14） reported that they could master the emergency treatment of some common critical pediatric diseases，and 71.4%（10/14） believed that they had mastered the rules in pediatric drug therapies. Compared with untrained GPs，the willingness of trained GPs to carry out pediatric diagnosis and treatment and carry out pediatric outpatient service time were different（P<0.05）. A few months of operating a pediatric clinic showed that the visits for the clinic in most CHCs were less than 5 in half a day. 64.3%（9/14） of the GPs were willing to participate in more pediatric trainings. Conclusion　The trained GPs thought that their competencies for delivering outpatient pediatric services were increased by training，but they had insufficient experience in pediatric consultations. Further improvement will be needed in introducing more pediatric medicines，increasing pediatric laboratory testing programs and promoting more clinical visits.

Development of a Tool for Community Health Institutions to Rapidly Evaluate the Feasibility of New Services　

LI Liqiu，XU Chengyan，ZHAO Liang，CHEN Guorong，CHEN Junxiang

2021, 24(19): 2489-2493. DOI: 10.12114/j.issn.1007-9572.2021.00.173

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Background　As community health，general medicine and family doctor systems become increasingly well known，the upstream and downstream supply chains for community health institutions are seeking more opportunities to cooperate with community hospitals and their general practitioner（GP） teams in an effort to implement large quantities of various types of high-quality projects and to use featured technologies，etc. During the process，GPs are required to know the latest developments in the market. What's more，they should know how to evaluate and choose an appropriate project or technology that is worth investing time to negotiate to reduce the possibilities of making errors in attempts and misjudging market opportunities. Objective　To develop an auxiliary tool for evaluating the feasibility of integrating a project，technology or business into family doctor services，to help an independent practice GP team to make decisions rapidly，efficiently and precisely. Methods　From August to October 2019，we conducted a brainstorming session on technologies appropriate for community-based implementation and promotion with individuals invited from Shanghai，including 5 GPs as the session leaders with differences in seniority，background，workplace and district，3 senior community health practitioners （1 community health counselor，1 community health managers，and 1 manager of a GP team delivering family doctor services） as the session host and organizer，and 1 professional with project management experience and knowledge of community health affairs as the recorder of the session. According to the session，we summarized the necessary and sufficient conditions and evaluation criteria that are used to assess whether a technology，service or project is suitable to be implemented by a community hospital，and estimated their values by testing the ongoing representative projects in 7 sampled community hospitals. Results　The finally developed tool contains 7 assessment criteria：（1）The project，service or technology can be implemented by the community hospital；（2）The service can only be accessed in the community hospital （for achieving maximum treatment convenience by using geographical advantage of community hospital）；（3）The project，service or technology can be used to satisfy the needs of patients with an illness of high morbidity and prevalence；（4）The implementation of the project，service or technology can show effectiveness rapidly；（5）The implementation of a project，service or technology is low cost；（6）The project，service or technology is appropriate for GPs or a GP team to implement in working hours and normal healthcare settings；（7）The implementation of the project，service or technology shall be paid service. A project，service or technology meeting all the above criteria was defined as with good feasibility，if not，it could not be implemented hastily. With regard to the ranking of the ongoing projects of the 7 community hospitals in terms of total score assessed by the 7 criteria，the top one scored 5.8 points，and the bottom one scored 2 points；3 scored above 4 points，50% had incomplete data，which were partly consistent with the actual implementation status. Among the criteria，the one of highest difficulty was criterion 7，followed by criteria 5，6，4，and 2，and the one of highest simplicity was criterion 1，followed by criterion 3. And criteria 6 and 7 were the most easily overlooked. Conclusion　Our tool with 7 criteria，has proved to be feasible for use with practicability，which may help a GP team to make evidence-based decisions accurately and high-efficiently.

Development of a Tool for Community Health Institutions to Rapidly Evaluate the Feasibility of Single Disease Prevention and Control Services　

CHEN Junxiang，CAO Yongqi，DING Qing，WANG Xiongxing，LI Liqiu

2021, 24(19): 2494-2500. DOI: 10.12114/j.issn.1007-9572.2021.00.174

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Background　During the development of featured services and specialties，it is necessary for community health institutions to choose or determine an appropriate option in the light of their own limited resources，and contradictions between diversified demand and requirements for healthcare of government，market，residents and healthcare disciplines. Objective　To develop an auxiliary tool for community health institutions to rapidly evaluate the feasibility of prevention and treatment services for a single disease，providing a reference for the establishment of single disease care unit in community hospitals. Methods　This study was conducted between December 19，2017 and October 28，2019 using semi-structured interviews with a group of 6 experts from fields of general care，public health，rehabilitation and community management on topics such as the principles，requirements and targets for establishing a single disease prevention and treatment unit in the community hospital and the designed roles of this unit，and using a questionnaire survey with 20 experts from community，general and TCM hospitals and a college on discussing the values of single disease screening principles and methods for evaluating the feasibility of single disease clinical pathway construction in a community hospital summarized from the results of above-mentioned semi-structured interviews and screened the eligible ones using boundary value analysis. In accordance with the investigation results，the Single Disease Screening Flow Chart for Constructing a Pathway to Community-based Care was developed. Results　Twenty-five single disease screening principles were determined finally，including four exclusion principles，and 21 admission principles. The admission principles cover historical data analysis（10 items，with weights sorted by the value of item-related information collected by community information department），and subjective scoring（11 items，each using a 7-Point Likert Scale to score the manifestations of a single disease）. The three diseases with the highest scores in total were determined as the first choice for a community hospital to build a clinical care unit for the diseases. Conclusion　Our tool includes 25 single disease screening principles with detailed measurements and implementation procedure，which is worthy of promotion owing to its theoretical scientificity and representativeness and practical feasibility.

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