Chinese General Practice

Interpretation of Screening for and Managing the Person with Frailty in Primary Care：ICFSR Consensus Guidelines　

LIU Pan, LI Yun, MA Lina

2021, 24(25): 3141-3147. DOI: 10.12114/j.issn.1007-9572.2021.00.222

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Frailty is a common clinical syndrome in older adults，often coexists with other diseases，which could increase an individual's vulnerability for developing increased risk of dependency and/or death. Due to the lack of geriatric clinicians and insufficient awareness of frailty screening in community-dwelling older adults，the frailty in these older people often progresses to disability，affecting their physical function and quality of life. Early frailty screening and interventions for older adults in primary care is an important way to prevent the progression of frailty and maintain physical function. In 2020，the International Conference on Frailty & Sarcopenia Research（ICFSR） developed the guidelines on screening for and managing the person with frailty in primary care. The guidelines proposed seven rapid frailty screening tools and two frailty management methods suitable for primary care，providing practical strategies for frailty screening and management in primary care. We mainly interpreted frailty screening and management parts in the guidelines，which will help the screening for and managing Chinese older adults with frailty in the community.

Interpretation of 2020 American College of Rheumatology Guideline for the Management of Gout from the Perspective of General Practitioners　

LIU Min，MENG Juan

2021, 24(25): 3148-3153. DOI: 10.12114/j.issn.1007-9572.2021.00.133

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The recent updates of guidelines for the management of gout have gradually promoted the standardization of gout diagnosis and treatment. What's more，the newly released 2020 American College of Rheumatology Guideline for the Management of Gout has made some vague concepts to be clear. As general practitioners play a vital role in the management of gout，a common and frequently-occurring disease，we interpreted the 2020 American College of Rheumatology Guideline for the Management of Gout from their perspective，and compared it to the latest Chinese guideline for the management of gout，offering proposal ideas to help general practitioners with the diagnosis and treatment of gout.

Information Technologies Used in General Practices Abroad：a Systematic Review　

ZHOU Junjie, YU Ruoxuan, SHI Weili, WANG Liuyi, ZHAN Xiaomin, CAI Chengcheng, WEI Huiying, LAO Xinling

2021, 24(25): 3154-3160. DOI: 10.12114/j.issn.1007-9572.2021.00.269

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Background　Along with the vigorous development of "Internet plus healthcare"，various information technologies（ITs） have been applied to general practices to varying degrees in China. However，studies on domestic "Internet plus general practices" are still very limited compared to those on "Internet plus specialty practices". Objective　To review the typical applications of ITs in general practices abroad and relevant research topics to reveal the research hot topics and future trend in this field，providing insights into general medicine research and practices in China. Methods　We searched the electronic version of top 10 SCI-indexed primary healthcare journals ranked by the JCR in terms of the value of impact factors in 2020 for articles about ITs used in general practices abroad using seven search terms：Information Technology，Information and Communication Technology，Internet，Web 2.0，Social Media，Online Health Community，and Online Support Group. Inductive and comparative analyses of the typical applications and research hotspots were performed. Results　The typical IT applications in general practices abroad include developing national electronic medical record systems，intensive application of data，decision support systems for general practitioners，video consultation and other alternative virtual consultations，intra- or inter-team collaboration of general practice teams，data collection outside hospitals，and publicity and demonstration of general practice teams. Research topics include the usefulness of IT applications in general practices，technology adoption and continuous use by general practice teams and patients，IT-enabled patient education and general practice education，intensive application of electronic medical records，and ethical issues related to IT use in general practices. Conclusion　This review recommends the following measures to be taken to promote domestic application of ITs in general practices against the backdrop of developing general practice and electronic medical record system backed by the Chinese government：Proactively using new and emerging ITs to build an IT-enabled general practice service ecosystem. For example，using the 5G technology to improve remote medical services，the service capacity of community healthcare settings，the services delivered by a regional medical consortium，the development of a tiered healthcare system and the services by the general practitioner as a gatekeeper. Using the informationization level of electronic medical record system as an evaluation criterion for hospitals，for example，hospitals should use grade 9 electronic medical record system to report data to the National Health Commission of the People's Republic of China，thereby promoting the building of a national electronic medical record system. Strengthening the construction of integrity and continuity of patient data management system using ITs，and improving the accuracy of diagnosis and treatment decisions made by general practitioners using machine-learning and other big data algorithms. Encouraging the implementation of interdisciplinary studies by general practice teams in collaboration with researchers in the field of information management and system，to promote domestic development of general medicine practice and research comprehensively.

Prevalence and Factors Associated with Polypharmacy in Community-dwelling Older People：a Systematic Review　

LI Li, LI Sha, WEI Yun, ZHANG Yuanyuan, YAN Li'e

2021, 24(25): 3161-3170. DOI: 10.12114/j.issn.1007-9572.2021.00.204

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Background　The number of older people needing pharmaceutical treatment due to multimorditiy is increasing along with population aging and the increase in longevity. Polypharmacy has become a major global public health problem. Objective　To assess the prevalence and factors associated with polypharmacy in community-dwelling older people，in order to provide evidence for reducing polypharmacy prevalence and medication-related harm as well as formulating public health interventions. Methods　We searched studies regarding prevalence of polypharmacy in community-dwelling older people published from 2000-01-01 to 2021-01-01 in English from databases of Medline，Embase and Cochrane Library，and those in Chinese from databases of CNKI and Wangfang Data. Data extraction and quality evaluation of the included studies were performed. RevMan 5.4 was used for meta-analysis. Results　Forty-nine studies met the inclusion criteria. Meta-analysis indicated that the pooled prevalence of polypharmacy and excessive polypharmacy in community-dwelling older people was 37% 〔95%CI（34%，39%）〕 and 14%〔95%CI（12%，16%）〕，respectively. 13 studies performed multivariate statistical analyses identifying independent variables associated with polypharmacy. Positive associations were found for multiple chronic diseases/ multimorditiy（n=7 studies），older age（n=6 studies），being overweight or obesity（n=5 studies），poor self-reported heath（n=4 studies），limitations in actitivities of daily living（n=4 studies），low education attainment（n=4 studies），self-reported diabetes （n=3 studies），self-reported hypertension（n=2 studies） and self-reported heart disease（n=2 studies）. Conclusion　Polypharmacy is highly prevalent and excessive polypharmacy is relatively common in community-dwelling older people. Identification of factors associated with polypharmacy is important for identifying and monitoring the elderly groups most vulnerable to this problem. Therefore，when formulating community interventions for polypharmacy，especially for chronic disease prevention and management，various associated factors of polypharmacy should be taken into account. Doctors and pharmacists should write evidence-based prescriptions to ensure rational use of medicines. Additionally，developing a healthy lifestyle may be a public health intervention contributing to the reduction of chronic disease and polypharmacy prevalence.

Thinking，Judgement and Decision Making in the Prevention and Control of COVID-19 Leon Piterman

Leon Piterman

2021, 24(25): 3171-3174. DOI: 10.12114/j.issn.1007-9572.2021.00.293

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Policy Responses of Primary Care to Public Health Emergencies：a Policy Tool-based Analysis　

DU Xinyi，XIA Lu，DUAN Yuwei，ZHANG Jianing，LU Jiaying，WU Fang

2021, 24(25): 3175-3183. DOI: 10.12114/j.issn.1007-9572.2021.00.248

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Background　The front line of the fight against public health emergencies is primary care，so the response policy system for the emergencies is a guarantee to enhance primary care response abilities. Objective　To perform a policy analysis of the priorities and trend of changes in policies regarding primary care response to public health emergencies，and to put forward recommendations for improving the insufficiencies. Methods　Thirty-five policy documents regarding primary care response to public health emergencies issued by China's central government between 2009-03-17 and 2020-08-30 were selected，and quantitatively analyzed using content analysis from aspects of policy tools，policy responsible parties and emergency management cycle. Results　A total of 99 reference points were obtained from 35 policy texts. Unidimensional analysis demonstrated that policy tools with the highest proportion in X，Y and Z dimensions were demand-side policy tools（53.5%），government and relevant departments（44.4%） and response policy tools（74.7%），respectively. In the two-dimensional analysis，the most frequently used policy tool for government departments was supply-side type. For primary medical institutions，community，subdistrict or rural areas，demand-side type was often used. There were fewer supply-side policies in terms of healthcare workforce and healthcare resources in mitigation and preparedness phases，and many demand-side policy tools in response and recovery phases. The government departments and the primary health institutions were involved in each phase of the emergency management cycle，while healthcare workers，community，subdistrict or rural areas were not covered at every phase. In the three-dimensional analysis，policy tools was less used in both preparedness and recovery phases in general，only a few demand-side and environmental-side policy tools were applied to government departments，institutions of disease prevention and control and the primary health institutes. In the preparedness phase，supply-side policy tools were used the most for each policy responsible party. When entering the response phase，the policy tools for each party significantly increased，and the use of demand-side policy tools tended to be higher in primary health institutions. Conclusion　The policy system of China's primary care response to public health emergencies is still under construction. The distribution of policy tools is significantly different，with a focus on demand-side rather than supply-side and environment-side. The distribution of policy responsible parties is unbalanced，mostly involving the government and primary medical institutions，but neglecting the participation of collaborative agencies. The policies fail to fully cover the emergency management cycle，focusing on response but neglecting prevention and recovery. Therefore，it is recommended that policies associated with public health emergency management should be developed with four aspects fully taken into consideration: features of each phase of emergency management cycle，appropriately optimizing the proportion of different types of policy tools，balancing the distribution of policy responsible parties，and strengthening the construction of preparedness and recovery phases of emergency management.

Improving the Development of Public Health Emergency Preparedness and Response System via Reinforcing Primary Care in Pandemic and Non-pandemic Periods　

HUANG Jiaoling，HUANG Hao，LIANG Hong，FANG Fei，CUI Yaqi，CHEN Chen，CHEN Shuqin，TANG Lan，WANG Zhaoxin，CHANG Wei，YAO Yufeng

2021, 24(25): 3184-3189. DOI: 10.12114/j.issn.1007-9572.2021.00.247

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Background　Since the outbreak of COVID-19，the ability to manage public health emergencies in mega-cities has been put on the policy agenda，and the role of primary care in public health system is critical. Objective　To explore the status，problems and challenges of practical exploration of Shanghai's primary care in responding to COVID-19，providing policy recommendations and decision-making basis for improving the public health emergency system. Methods　 From June to September 2020，a qualitative study was conducted using group interviews with administrators and healthcare professionals selected from 10 representative community health centers（CHCs） in suburban，fringe and urban areas in Shanghai's 5 districts for exploring major tasks shouldered by the CHCs，organizational structure of the CHCs，actual tasks performed by the CHCs，internal collaboration，major problems in service delivery during the pandemic，and recommendations，and with directors，as well as professionals responsible for information，healthcare management and quality control，public emergency management and infectious disease containment selected from health commissions and centers for disease control and prevention in the districts，for exploring the functions and roles of CHCs during the pandemic and their weaknesses in anti-pandemic actions，anti-pandemic supports from health commissions and centers for disease control and prevention for CHCs，and ideas about actions of primary care in pandemic and non-pandemic periods. The interviews with individuals from three kinds of affiliations were guided using different types of semi-structured outlines developed by our research team. Results　 The interviews revealed that during the pandemic，the CHCs gave emergency responses to COVID-19，participated in regional collaboration for COVID-19 containment，delivered in-hospital COVID-19 screening and triage services while providing routine medical services，and continued to offer family doctor services. Four issues were found to be addressed： insufficient healthcare resources and workers，insufficient services targeting psychological influence of COVID-19，unsatisfied internal coordination and multi-departmental management，and lack of appropriate mechanisms incentivizing healthcare workers and invigorating primary care. Conclusion　In view of the challenges in fighting COVID-19 faced by primary care，it is recommended to take actions on the basis of appropriately balancing the delivery of routine primary care services and public health services，and tasks during pandemic and non-pandemic periods，and appropriately coordinating with higher level departments，as well as developing incentive programs according to the local conditions as a supplement for the government programs.

Difficulties and Solutions for the Family Doctor Team in Preventing and Managing Public Health Emergencies：a Study Using the Value Chain Approach　

GUO Yifan，ZHU Xian，ZENG Zhirong

2021, 24(25): 3190-3196. DOI: 10.12114/j.issn.1007-9572.2021.00.272

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Background　Currently，the family doctor team still faces many obstacles in managing public health emergencies as the gatekeeper. However，there is little research on the difficulties of family doctor teams in the prevention and management of public health emergencies. Objective　To explore the difficulties of family doctor teams in the prevention and management of public health emergencies，providing a theoretical basis and recommendations on ensuring the highly efficient performance of family doctor teams in preventing and managing the emergencies. Methods　Convenience sampling was used to select frontline healthcare workers from 25 primary healthcare institutions of Guangzhou to complete an online survey using a self-administered questionnaire conducted in June 2020 for investigating the implementation of essential public health services，essential medical services and prevention and management of public health emergencies in their hospitals between February and June 2020. Interviews were conducted with some of the healthcare workers who volunteered to be interviewed. Results　According to the questionnaire survey，during February to June 2020，of the 25 institutions，19 had halted the delivery of some or all essential public health services，6 had no capacities and channels to transfer suspected or confirmed COVID-19 cases to designated COVID-19 hospitals，24 had implemented the emergency response plan for the COVID-19 pandemic，10 had offered COVID-19-related health education，9 had not set up the infectious diseases and public health emergencies reporting and managing system，10 had not established the fever clinic，and 11 had operated all the clinics as usual. Value chain analysis of the interviews indicated that difficulties faced by the family doctor team in preventing and managing public health emergencies were：insufficient in-hospital support，unsuccessful communication and collaboration between hospitals or between the hospital and other institutions，poor monitoring and early warning effect of the COVID-19 pandemic，insufficient COVID-19-related health education，residents' unmet needs of essential medical services，inadequate emergency response infrastructure，lack of public health professionals，discrepancy between the construction of various information systems，inappropriate emergency procurement system. Conclusion　To make the community a solid fortress for the prevention and management of public health emergencies to ensure residents' health and safety，the authors suggest that efforts shall be made to address the barriers to the implementation of essential medical services first，then to solve issues existing in the implementation of auxiliary services.

Application of Standardized Workload in Primary Healthcare Management　

LIN Jixiang，GU Jinghua，WANG Tianying，HUANG Shuxian，JIAO Lulu，GAO Jun，JIANG Wenzhen，ZHANG Wenyu，MA Junling，YANG Huilan，SHEN Yongmei，KANG Jie，CHEN Biao，ZHOU Jingyu，ZHANG Lina，GUO Haiying

2021, 24(25): 3197-3204. DOI: 10.12114/j.issn.1007-9572.2021.00.184

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Background　In the context of the government's increasing pace of controlling the cost of primary healthcare，primary healthcare institutions are in urgent need of convenient，easy-to-use，and popular management tools to help to address issues commonly encountered in labor cost accounting，service performance distribution，new service development，service pricing，academic construction and talent training. Various common problems solved in the operation process. The standardized workload has been applied to healthcare sector in 2015. As a tool for accurately measuring the manpower consumption in delivering a service，the parameters and variables used in the measurement process involve the aforementioned various aspects，and can be calculated through accurate statistics. The resolution of the above problems is clarified and quantified，forming a closed decision loop. Objective　To clearly explain the meaning，definition，operation definition，and various application methods of the standardized workload，facilitating the understanding，grasp and application of this tool in institutional operation and management，thereby quickening the development of primary healthcare institutions to achieve successful operation and reasonable cost control. Methods　On the basis of good understanding of the meaning of standardized workload，we chose key variables and parameters associated with each issue in institutional operation and development，and put them into the formula for calculating the standardized workload via various meaningful combinations，and analyzed them in detail. Results　Standardized workload could address the issues commonly met in labor cost accounting，service performance issuance，new service development，service pricing，academic discipline construction and talent training. Conclusion　Standardized workload may help to quantify the government funding，intra-institution performance allocation，and the price for newly developed featured services. Moreover，it may be used for estimating the value of service improvement by quantifying pre- and post-improvement service efficiencies，and for developing new technologies and businesses as an evidence-based tool for provoking innovative ideas.So appropriate application of standardized workload in the community could accelerate the development of community health as a discipline and the training for community health workers.

Methods for Accurately Assigning the Value of Technical Difficulty and Risk Degree of Standardized Workload of Community Health Services 　

LIN Jixiang，GU Jinghu，WANG Tianying，HUANG Shuxian，JIAO Lulu，GAO Jun，JIANG Wenzhen，ZHANG Wenyu，MA Junling，YANG Huilan，SHEN Yongmei，KANG Jie，CHEN Biao，ZHOU Jingyu，ZHANG Lina，GUO Haiying,et al

2021, 24(25): 3205-3209. DOI: 10.12114/j.issn.1007-9572.2021.00.220

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Background　The calculation formula of standardized workload includes three variables:manpower time，technical difficulty and risk degree. Among them，technical difficulty and risk degree are subjective measurements. Business personnel in different departments or engaging in different types of work have their own measures. In general，the workload measurement of business personnel of the same type of work is relatively consistent. But it is impossible to use the same criteria to measure the workload of people in different departments or engaging in different types of work，which makes the technical difficulty and risk measurement of different departments incomparable. Objective　 To estimate the standardized workload of community health services to homogenize the subjective measurements of technical difficulty and risk degree of workload across departments. Methods　 We collected the initial assignment values of each service（including manpower hour，technical difficulty and risk degree） delivered by representative professional workers from pharmaceutical and healthcare business departments. Then，using the calculation principle of standardized workload，we converted them according to the principles of minimum and average，and multiplied the converted values of technical difficulty and risk degree by inter-department conversion coefficient obtained by using the series method to obtain the final comparable values of the technical difficulty and risk degree of different departments，with the sorting method used for solving the controversy before determining the final value. Results　The degree of authority of the invited experts for consultation was greater than 0.7，and the results were scientific and reliable. The technical difficulty and risk degree conversion coefficients between departments were obtained. And the final comparable values for technical difficulty and risk degree of all services delivered by each department were obtained. Conclusion　The measurement and evaluation of the standardized workload of each service in terms of technical difficulty and risk level，requires the selection of representative professional workers to obtain their evaluation results，and then adopts the minimum and average principles，series method，and sorting method，the final comparable values of technical difficulty and risk level for each service delivered by different business departments within a hospital can be successfully obtained.

Effect of Standardized Workload Used in Comprehensive Performance Management in Community Health Institutions: a Practice-based Analysis　

LIN Jixiang，GU Jinghua，WANG Tianying，HUANG Shuxian，JIAO Lulu，GAO Jun，JIANG Wenzhen，ZHANG Wenyu，MA Junling，YANG Huilan，SHEN Yongmei，KANG Jie，CHEN Biao，ZHOU Jingyu，ZHANG Lina，GUO Haiying，et al

2021, 24(25): 3210-3220. DOI: 10.12114/j.issn.1007-9572.2021.00.183

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Background　Standardized workload is a tool that can be used by community health institutions to accurately measure the manpower consumption in delivering a service. The parameters and variables used in the calculation of standardized workload may involve all aspects of the development of such institutions. Therefore，this tool is highly applicable. However，there is a lack of research on guiding the practical use of it in the operation and comprehensive assessment of community health institutions. Objective　To comprehensively and systematically analyze the application of standardized workload in staff performance management by Beicai Community Health Center，providing evidence for organizing the services of a health institution，and for using standardized workload to measure the workload of newly developed services，and to build a relationship between different business departments. Methods　A real-world research design was used. The measurement of standardized workload by Beicai Community Health Center was discussed in terms of themes（n=4） and steps（n=6）. Results　The actual operation process，applied principles and formulas for measuring the performance of all employees and for pricing new services were summarized. Conclusion　The experience of Beicai Community Health Center analyzed in detail may be directly used by other community health institutions to guide the measurement of standardized workload，including the pricing of newly developed services，performance assessment for workers in different departments，and so on，which may help to maintain the unity of operation strategies of the institution.

Prevalence and Associated Factors of Periconceptional Folic Acid Supplementation in Yunnan Women of Childbearing Age　

WU Yu，YUAN Yanling，KONG Cai，MA Qiuyue，JING Wenzhan，YE Hanfeng，LIU Jue，LIU Min

2021, 24(25): 3221-3226. DOI: 10.12114/j.issn.1007-9572.2021.00.243

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Background　Periconceptional folic acid supplementation is an effective measure to prevent neural tube defects（NTDs），and the preventive effect is influenced by the dosage and duration of folic acid intake. In 2019，"folic acid supplementation to prevent neural tube defects" has been listed as a national essential public health service in China. Objective　To investigate periconceptional folic acid supplementation prevalence and its associated factors in women of childbearing age in China's Yunnan，to provide evidence for improving the effect of folic acid intervention. Methods　Data used in the study（n=33 173） were collected from an early pregnancy follow-up survey among women of childbearing age from 16 cities and prefectures of Yunnan Province who participated in the National Free Preconception Health Examination Project in 2018，and completed the follow-up. Their periconceptional use of folic acid supplements and associated factors were analyzed. Results　In 2018，93.81%〔95%CI（93.55%，94.07%）〕 of the participants took folic acid supplements during their pregnancy，but only 47.16% 〔95%CI（46.62%，47.70%）〕as recommended. The prevalence of supplementation and appropriate supplementation with folic acid in the periconceptional period varied greatly across the cities and prefectures. But in general，most cities and prefectures had a high prevalence of periconceptional folic acid supplementation（above 85%），and a relatively low prevalence of appropriate supplementation. The lowest prevalence of appropriate supplementation was found in Wenshan Zhuang and Miao Autonomous Prefecture（27.47%）. Multivariate Logistic regression analysis showed that age，education level，occupation and residential areawere associated with periconceptional folic acid supplementation（P<0.05）. Age，education level，history of childbirth，history of abortion，and residential area were associated with appropriate use of folic acid supplements in the periconceptional period（P<0.05）. Conclusion　Overall，the prevalence of periconceptional folic acid supplementation in Yunnan women of child-bearing age was high，but the appropriate use prevalence was relatively low，with significant inter-region or inter-prefecture differences. To improve the situation，it is suggested to give priority to periconceptional folic acid supplementation and health education in younger women，and those with low education level，farming as an occupation，childbirth history or abortion history.

Clinical Application of Balance Disorder Rehabilitation-assisted Robot in Postoperative Rehabilitation of Elderly Patients with Fall-related Lower Limb Fractures　

FENG Yuning，LI Kainan，JIA Zishan

2021, 24(25): 3233-3237. DOI: 10.12114/j.issn.1007-9572.2021.00.260

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Background　According to the results of China's seventh national census，Chinese population aged 60 and above is 264.02 million，the proportion of which，compared with that of 2010，has increased by 5.44 percentage points. The accelerated population aging has aroused increased concerns about postoperative rehabilitation of elderly patients with lower limb fractures after fall. Given many unfavorable factors for postoperative rehabilitation，such as lack of rehabilitation physicians，few rehabilitation schemes，and nonuniform subjective judgment of rehabilitation physicians，robot-associated balance disorder rehabilitation might be a safer and more effective rehabilitation training choice. Objective　To explore the clinical effect of balance disorder rehabilitation-assisted robot in postoperative rehabilitation of elderly patients with fall-related lower limb fractures. Methods　One hundred elderly patients with lower limb fractures caused by fall were recruited from Orthopedic Ward，Affiliated Hospital of Chengdu University and Chinese PLA General Hospital from April to October 2020，and equally divided into case group and control group using a computer algorithm，receiving physical exercise therapy with robot-assisted balance disorder rehabilitation，physical exercise therapy with walking for weight loss，respectively. Major indicators for postoperative rehabilitation effect were stride time，speed of 3-meter straight walking and step size of 3-meter straight walking measured by the attitude sensor at the end of the 16th week of postoperative training，and the Berg Balance Scale score measured at the end of the 8th，12th and 16th weeks of postoperative training. Results　All the participants were included for final analysis except 5 dropouts（3 in the case group，and 2 in the control group）. Two groups showed no significant differences in gender ratio，and mean age and BMI（P>0.05）. The mean course of fractures differed significantly between the groups（P<0.05）. The case group had much shorter mean left and right stride time than the control group（P<0.05）. The case group had quicker average speed of 3-meter straight walking and greater average step size of 3-meter straight walking（P<0.05）. The interaction between training contents and time was statistically significant in both groups（F=53.116，P<0.001）. The recovery degree of lower limb motor function was different between the two groups（F=3.675，P=0.013）. The Berg Balance Scale scores for both groups differed significantly by measurement time（F=1 364.425，P<0.001）. Conclusion　For older adults with fall-related lower limb fractures，robot-assisted balance disorder rehabilitation may yield a better outcome concerning lower limb motor function recovery compared with walking for weight loss，but the speed of recovery may slow down with the extension of rehabilitation time.

Demand for Home Care Services in the Elderly in the Community：a Structural Study　

DAI Lili，DUAN Yanqin，ZHANG Mei，CHEN Juan，SUN Yuling，LI Zhuoran，HE Sifang

2021, 24(25): 3238-3243. DOI: 10.12114/j.issn.1007-9572.2021.00.226

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Background　In Huaibei region recently，the general population has demonstrated low rate of making appointments in contrast to high rate of contracting family doctor services，but the community-dwelling older people has showed high demand for home care services urgently. Studying the structural characteristics of the demand for medical services in elderly people is of great significance for precisely implementing interventions and maintaining public health. Objective　To analyze the structure of community-dwelling older people's demand for home care services，providing a basis for delivering home care services appropriately for such people. Methods　We conducted a survey using a self-developed questionnaire named Older People's Demand for Home Care Services among 2 137 elderly people selected from Huaibei region using cluster random sampling during October to December 2019. The Kano model was used to categorize and prioritize the demand. Results　A total of 1 924 valid questionnaires（90.03%） were collected. In all，there were 21 home care services belonging to five categories needed by these older people. Of the 15 with attractive attributes（physiological indices examination，regular physical examination，free expert consultation，home follow-ups，creating and maintaining health records，health consultation，preventive healthcare education，medication guidance，rehabilitation guidance，healthcare lectures，home-based medical care，emergency treatment，bed-ridden care，treatment-seeking assistance，and drug delivery），regular physical examination was needed most，and emergency treatment was relied on most heavily. Other six（hospice care，psychological counseling，rental services，remote medical care，medical insurance services，and healthcare policy publicity） have indifferent attributes. Conclusion　Our study indicates that community-dwelling older people in Huaibei region had seemingly low level of demand for medical care services，which may be caused by lack of knowledge and experience of home care services，and unexpressed potential needs. Clearly identifying the demand structure in older people living in different urban communities，and delivering targeted interventions will boost the implementation effectiveness of relevant healthcare policies，ensuring a good balance between supply and demand in healthcare.

Development of a System for Assessing Family Doctor Team Members' Performance by the Team Leader　

ZHANG Jingyu，LIU Lixia，WANG Xiaogang，YE Jingxue，LIAO Xiaoyang，TAN Xue，DAI Xiaoyi

2021, 24(25): 3244-3249. DOI: 10.12114/j.issn.1007-9572.2021.00.147

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Backgroud　Since 2014，Chengdu's Wuhou District has initiated primary care transformation，delivering person-centered active care by the family doctor team，and assessing the team performance as well as each member's performance（by the team leader）. However，there is no available easy-to-use system for assessing the team members' performance scientifically，rationally and effectively by the team leader. Objective　To develop a system for assessing the performance of each member of a family doctor team by the team leader，offering guidance on carrying out rational and scientific performance assessment within the family doctor team. Methods　We used literature review to develop the first draft of a system for assessing the performance of family doctor team members by the team leader. Based on this draft，we developed a questionnaire and used it to conduct two rounds of surveys with relevant experts using the Delphi technique between July 2019 and February 2020 for obtaining their ideas and opinions，and determined the content of the system after revising it according to the survey results. We determined the weight of each dimension，index and subindex of the system by principal component analysis. Results　The response rates of the two rounds of expert consultation were 100.0%（35/35） and 100.00%（25/25），respectively. The mean coefficients of Cs，Ca and Cr were（0.71±0.05）（0.79±0.12）（0.87±0.09） for the first round of survey，respectively，and were（0.74±0.13）（0.88±0.10）（0.81±0.10） for the second round of survey，respectively. The Kendall's W for the first and second consultations were 0.177（χ2=322.054，P<0.001） and 0.215（χ2=242.762，P<0.001），respectively. The final system consists of 3 dimensions，10 indices and 23 subindices，with corresponding weights assigned. Specifically，the dimensions include face-to-face services，non face-to-face services，face-to-face services/non face-to-face services，with weights of 0.400 0，0.100 0，0.500 0，respectively. Conclusion　This system for assessing the performance of family doctor team memebers by the team leader could be used as a tool for objectively and scientifically evaluating the performance of family doctor team memebers.

Development，Reliability and Validity of the Satisfaction with Community-based Internship in General Medicine Scale　

KONG Yan，ZUO Yanli，LI Hong

2021, 24(25): 3250-3257. DOI: 10.12114/j.issn.1007-9572.2021.00.198

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Background　 The satisfaction with community-based internship is a key indicator of the system for assessing the quality of general practice teaching in community-based settings. Timely and accurate assessment of the satisfaction is essential for understanding and improving the quality of community-based clinical teaching. Objective　To make and evaluate the reliability and validity of the Satisfaction with Community-based Internship in General Medicine Scale（CIGMS）， providing a quantitative tool for evaluating the quality of community-based clinical teaching. Methods　From September 2017 to September 2019，Cluster sampling method was adopted to select 475 clinical medical graduates（trained with the rural-oriented tuition-waived medical education program） admitted to Guangxi Medical University during 2010 to 2014 to attend a survey with a self-made questionnaire named CIGMS to carry out item，reliability and validity analyses of the CIGMS. Results　The Cronbach's α coefficient for the final scale was 0.974，and for its dimensions ranged from 0.849 to 0.941. The KMO index was 0.957，and Bartlett's test was also acceptable with P<0.001（χ2=8 480.538），indicating that the exploration factor analysis could be performed. The confirmatory factor analysis showed an acceptable fit with χ2/df=1.874，GFI=0.784，NFI=0.848，RMSEA=0.061，CFI=0.921，and IFI=0.922. The final CIGMS is consisted of 6 dimensions and 40 items，and the dimension-total correlation coefficients were 0.851，0.885，0.778，0.899，0.888 and 0.766，respectively（P<0.01）. Conclusion　The CIGMS has been proved to be reliable and valid，which can be used to evaluate the quality of community-based clinical teaching as a comprehensive and effective tool.

Latest Advances in Management Models for Prediabetes　

LI Xixi，BIAN Sensen，GUO Qing

2021, 24(25): 3258-3262. DOI: 10.12114/j.issn.1007-9572.2021.00.148

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Diabetes and its complications are currently one of chronic non-communicable diseases that seriously threaten public health，showing an increasing incidence rate year by year. Prediabetes is a high-risk stage for normal glucose metabolism to develop into diabetes，and effective interventions received in this stage is the key to lowering the occurrence of diabetes. To identify a better management model feasible for prediabetes，we selected five representative ones（self-management，family participatory management，community-based group management，TCM management，and management with combined new technologies） from the available prediabetes management models，and performed a comparative analysis of their strengths and limitations. We recommend the management with multiple forms of interventions，which may effectively reduce the possibility of developing diabetes from prediabetes，with a broad application prospect.In addition，the management by a community health team including at least a health manager may be an innovative model for effectively managing prediabetes in the future.

Visualization Analysis of Hot Topics about Cardiac Rehabilitation in Studies in the Web of Science Database　#br#

LI Cuigang，ZUO Anju，LI Tingting，GUO Yuan

2021, 24(25): 3263-3268. DOI: 10.12114/j.issn.1007-9572.2021.00.134

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Background　In China，there are a large number of cardiovascular disease patients，which highlights the important role of cardiac rehabilitation in improving patients' prognosis and reducing their treatment burden. To promote domestic development of cardiac rehabilitation，it is necessary to review the international research hotspots in this field regularly. Objective　To understand the distribution of countries and institutions studying cardiac rehabilitation, and hot topics of cardiac rehabilitation research since 2000，providing scientific evidence for carrying out relevant research in China. Methods　With "(cardiac or heart) and rehab*" as theme，studies regarding cardiac rehabilitation included in the Web of Science Core Collection from 2000 to 2020 were searched in August 1，2020. VOSviewer 1.6.14 and CiteSpace 5.6.R3 were used to perform visualization analyses of the trend of publication，countries of publication，author institutions，and research hotspots of the eligible studies. Results　A total of 9 793 articles were included. The yearly number of publications was on the rise overall. The author institutions in developed countries have a long history of cardiac rehabilitation research and a great influence on this field. The topics in these studies mainly focused on：the exploration of new forms of cardiac rehabilitation，forms of exercise interventions，integrated health management and psychological interventions for cardiac rehabilitation. Conclusion　Our analysis indicated that for exploring forms of cardiac rehabilitation suitable for Chinese cardiovascular disease patients，priority should be given to strengthening the idea of patient-centered rehabilitation，with enough consideration on current research hotspots，and the use of the emerging technologies and family- and community-related factors.

Regional Disparities in Under-five Mortality and Potential Years of Life Lost in Yunnan，China，2015—2019　

YE Qingyun，QIN Mingfang，YANG Zhongting，DENG Rui，JIAO Feng，LI Benyan，ZHANG Yi，HUANG Yuan

2021, 24(25): 3327-3232. DOI: 10.12114/j.issn.1007-9572.2021.00.244

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Background　In the last several decades，the Chinese Government has made substantial progress in reducing under-five mortality rate（U5MR），but the disparity in U5MR between urban and rural areas still exists. Objective　To identify the main causes of death and potential years of life lost among children under 5 years old across different regions of Yunnan Province from 2015 to 2019. Methods　According to the poverty headcount ratio in 2017，a total of 129 districts and counties in Yunnan were categorized into severely impoverished，poor，and non-poor areas. Data about reported death among children under 5 years old in these areas during 2015—2019 were collected，and described statistically using the mortality rate，proportion of deaths by cause，potential years of life lost，potential years of life lost rate，and average years of life lost. Poisson regression model was adopted to estimate the trend in U5MR and its 95%CI during 5 years for three types of areas. Chi-square test was chosen to analyze the changes in death places during 5 years. The data source came from "population death information registration management system" of "China Disease Control and prevention information system" of Yunnan Center for Disease Control and Prevention. Results　U5MR in Yunnan had decreased by -28.23% for 5 years，at -7.60% per year on average〔95%CI（-8.52%，-6.76%）〕. The same decline trends happened in severely impoverished areas｛-29.51% for 5 years，-6.95% per year on average〔95%CI（-8.51%，-5.45%）〕｝，poor areas｛-13.34% for 5 years，-3.15% per year on average〔95%CI（-4.59%，-1.69%）〕｝，and non-poor areas｛-42.66% for 5 years，-13.76% per year on average〔95%CI（-15.38%，-12.10%）〕｝. The majority of under-5 deaths took place at home in severely impoverished areas，but the proportion had reduced by year. By contrast，the majority of under-5 deaths took place at hospital in poor areas and non-poor areas，and the proportions had reduced by year as well. The differences in death places among children under 5 years old in poor areas were statistically significant across years （P<0.05）. The top three causes of death were birth trauma and asphyxia，lower respiratory tract infection，and congenital heart disease in both 2015 and 2019. Low birth weight and birth trauma and asphyxia caused the highest average years of life lost. Conclusion　In Yunnan Province，the reported mortality rate of children under 5 years old showed a significant decrease in all three regions with different levels of poverty. Given that the disparities in child health between poor and non-poor areas have remained，and the massive loss of life years have caused due to early death，substantial efforts are needed in future to strengthen the capacity to provide perinatal care and to end preventable deaths among children under 5 years old in those underdeveloped areas that have been lifted out of poverty currently.

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