Chinese General Practice

Development of Reporting Items for Practice Guidelines in Primary Care

WANG Ping, ZHOU Qi, ZHAO Junxian, WU Shouyuan, SUN Yajia, LAN Hui, REN Mengjuan, SU Renfeng, WANG Ling, WANG Qi, LI Sheyu, HUANG Yanli, WANG Xiaohui, MA Yanfang, MA Li, XU Yanli, SUN Yange, SHI Ling, HUANG Yanyan, HOU Tianchun, GE Long, DU Zhaohui, ZHENG Yanling, YIN Zhaoxia, LI Tingting, ZENG Linan, ZHANG Xiaolong, REN Yanping, LIU Enmei, YI Chuntao, CHEN Yaolong

2023, 26(13): 1543-1550. DOI: 10.12114/j.issn.1007-9572.2023.0043

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Background

Clinical practice guidelines in primary care are important tools to guide primary care practice, but they are found with relatively low quality and unstandardized reporting on the whole.

Objective

To develop the reporting guideline for clinical practice guidelines in primary care based on the Reporting Items for practice Guidelines in HealThcare (RIGHT) .

Methods

According to the reporting methods recommended by EQUATOR Network, an item development group and an expert consensus group were established to develop reporting guideline for clinical practice guidelines in primary care. Content analysis, brainstorming, and topic analysis were used in developing the initial items. The Delphi survey was conducted to determine the final items.

Results

Thirteen items (five were modified and eight were added) were developed initially, covering five domains: guideline title, health issues, intended setting, recommendations and suggestions for future research. Then the initial item checklist was revised to a final version consisting of 15 items according to the results of two rounds of Delphi survey (with 100% response rates from 22 experts) conducted from December 2 to December 26, 2022.

Conclusion

This reporting checklist will provide a detailed guide for developers of guidelines in primary care, which will further improve the reporting quality of guidelines in primary care, especially that of those in China.

Current Situation Analysis and Quality Evaluation of Chinese Clinical Practice Guidelines in General Practice

WANG Ping, WU Shouyuan, SUN Yajia, LAN Hui, REN Mengjuan, ZHAO Junxian, WANG Ling, SU Renfeng, ZHOU Qi, WANG Zijun, WANG Qi, MA Li, HOU Tianchun, CHEN Yaolong

2023, 26(13): 1551-1558. DOI: 10.12114/j.issn.1007-9572.2023.0044

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Background

The clinical practice guidelines in general practice can improve healthcare quality in primary health care, however, no study has yet systematically investigated the current status and quality of the guidelines in China.

Objective

To investigate the current status and influencing factors of quality of the guidelines in China.

Methods

We searched China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Chinese biomedical literature database, and CQVIP website, and included the published guidelines in China. We analyzed the basic characteristics and used RIGHT to evaluate the reporting quality and AGREE-China for methodological quality.

Results

A total of 150 guidelines were included, mainly published from 2019 to 2021. Most of the guidelines〔108 (72.0%) 〕focused on the diagnosis and treatment of diseases. The top three specialties were cardiovascular disease〔40 (26.7%) 〕, gastroenterology〔31 (20.7%) 〕, and clinical pharmacy〔27 (18.0%) 〕. The main development institutions were the Chinese Medical Association and its branches〔123 (82.0%) 〕, the editorial committee of the Chinese Journal of General Practitioners〔119 (79.3%) 〕, and the Chinese Medical Journals Publishing House〔116 (77.3%) 〕. In terms of reporting quality, the average reporting rate of RIGHT was 23.6% (11.4%-42.9%) ; the reporting rate of basic information (59.8%) was higher, and that of evidence (0.3%) was the lowest. As for methodological quality, the average AGREE-China score was 23.4 (12.0-40.0) ; the reporting rates of conflicts of interest (63.0%) and availability/feasibility (53.0%) were higher, and that of economics (7.0%) was the lowest.

Conclusion

The number of Chinese clinical practice guidelines in general practice has increased rapidly in the past five years, which has played an important role in promoting the quality of primary health care. In the future, it is necessary to further develop the guidelines in different specialties and diseases and accelerate the methodology of development and reporting of the guidelines.

The Development, Problems and Application of Clinical Practice Guidelines: How Clinicians Can Read the Essence of Clinical Guidelines from the Surface to the Inside

YE Zhikang, YANG Hui

2023, 26(13): 1559-1567. DOI: 10.12114/j.issn.1007-9572.2022.W0002

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Evidence-based medicine has greatly contributed to the improvement of the level of medical services and health regulation. However, the critical use of the published medical literature and medical databases by Chinese clinical practitioners is insufficient, and the achievements of cutting-edge research methods of evidence-based medicine are not used by every Chinese clinical practitioner for benefit. This article provided a concise and well understood methodological illustration of the development of evidence-based medicine practice guidelines, to help Chinese clinical practitioners better understand the philosophy of guideline development by presenting the definitions of clinical practice guidelines and sorting out the standard development process of the guidelines. This paper analyzes from three parts, "Formulation of Clinical Practice Guidelines""Problems Existing in the Formulation of Clinical Practice Guidelines" and "How Clinicians Apply Clinical Guidelines". In this paper, the two guideline development standards, published by World Health Organization (WHO) and together with Guideline International Network (GIN) and McMaster University, were simplified, combined and summarized into were more concise. The problems existing in the formulation of clinical practice guidelines are analyzed with cases, in order to guide clinicians to apply the guidelines.

Summary of the Best Evidence for Dietary Nutrients Management to Promote Brain Health in Community-dwelling Residents

LIU Xiao, ZHANG Jinying, PENG Yan, WANG Li, CHEN Xiaomei, LIU Jia, DENG Menghui, YANG Yanni

2023, 26(13): 1568-1576. DOI: 10.12114/j.issn.1007-9572.2022.0753

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Background

Maintaining brain health is an advanced goal of healthy ageing. Eating a diet with appropriate nutrients has been identified as a promising approach to reducing the risk of dementia, but community-dwelling residents have inadequate or no health guidance from medical workers since there is no detailed and comprehensive clinical dietary nutrients management program for brain health promotion for community-dwelling people .

Objective

To search, evaluate and summarize the evidence on dietary nutrients management for brain health promotion in community-dwelling people, providing an evidence-based basis for clinical implementation of such management for this group of population.

Methods

In March 2022, we searched UpToDate, BMJ Best Practice, JBI Model of Evidence-based Healthcare, National Institute on Aging, Registered Nurses' Association of Ontario, the Cochrane Library, PubMed, CNKI, Medlive and other databases to collect literature (involving clinical decisions, recommended practices, guidelines, evidence summaries, expert consensuses and systematic reviews) regarding dietary nutrients management for brain health promotion in community-dwelling people. The retrieval period was from January 1, 2017 to March 29, 2022. Two researchers systematically trained in evidence-based medicine independently screened literature, extracted data, and evaluated the quality of the included literature. Then evidence was extracted from the included literature, and its quality was graded, then the best evidence was summarized.

Results

A total of 28 studies with an overall high methodological quality were included, including three clinical guidelines, five expert consensuses, one clinical decision and 19 systematic reviews. Finally, 23 pieces of best evidence were summarized, involving seven aspects of intervention timing, dietary nutrients assessment and screening, dietary patterns and components, specific nutrients, coffee intake, body weight management, health education and guidance.

Conclusion

Eating a diet with appropriate nutrients can promote brain health of residents. Community medical workers should develop an individualized dietary nutrients management program for brain health for them in accordance with the practical clinical situation, residents' current dietary nutrients status and preferences, and insights from the best evidence.

Dementia Risk Reduction Lifestyle Status and Influencing Factors among Community-dwelling Middle-aged and Elderly Adults

ZHANG Jinying, PENG Yan, LIU Xiao, WANG Li, LI Jie, YANG Yanni

2023, 26(13): 1577-1583. DOI: 10.12114/j.issn.1007-9572.2022.0748

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Background

Lifestyle factors are important modifiable influencing factors for cognitive decline and dementia. Understanding the status and influencing factors of community-dwelling middle-aged and elderly adults adhering to the lifestyles conducive to dementia risk reduction will be a basis for medical workers to formulate individualized interventions for primary prevention of dementia, yet there are still few related studies.

Objective

To understand the status and influencing factors of dementia risk reduction lifestyle in community-dwelling middle-aged and elderly adults.

Methods

Five hundred and six middle-aged and elderly adults (aged 45 years and older) who had received free health check-ups in a community health center were selected from five communities in Chongqing's Shapingba District by convenience sampling from January to October 2021. The self-designed general information questionnaire and the Dementia Risk Reduction Lifestyle Scale (DRRLS) were used to investigate. The level of DRRLS score in the participants was compare by sociodemographic characteristics. Ordinal and multinomial Logistic regression analysis was performed to identify the influencing factors of the levels of DRRLS scores.

Results

The average score of DRRLS was (88.00±13.27). The median scores of items in mental activity and brain-benefiting exercise were at a low level (≤2.00). The level of DRRLS score in the participants varied significantly by gender, age, personal monthly income and experience of receiving dementia-related health education (P<0.05). Ordinal and multinomial Logistic regression revealed that gender, educational level, personal monthly income and experience of receiving dementia-related health education were important influencing factors of the level of DRRLS score (P<0.05) .

Conclusion

In general, the lifestyles for dementia risk reduction were assessed at a moderate level in the community-dwelling middle-aged and elderly adults. In the primary prevention of dementia, the effects of mental activity and brain-benefiting exercise should be emphasized. Moreover, priority in community health management should be given to men, those with a low educational level or no previous experience of receiving dementia-related health education, and relevant health education and preventive interventions should be strengthened for them. All these efforts will urge these adults to adopt a lifestyle for dementia risk reduction and brain health promotion.

Effect of Dementia Prevention Beliefs on Health Promoting Lifestyle in Chinese Adults

LI Hua, ZHANG Jinying, WANG Li, YANG Tiantian, YANG Yanni

2023, 26(13): 1584-1589. DOI: 10.12114/j.issn.1007-9572.2022.0752

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Background

The incidence of dementia is gradually increasing in China. Lifestyle is an important modifiable factor for dementia, and the health belief model can be widely used to explain and predict health-related behaviors.

Objective

To analyze the impact of dementia prevention beliefs on health promoting lifestyle in Chinese adults, providing a scientific basis for the development of targeted dementia prevention regimens based on the health belief model.

Methods

An online survey was used for collecting data including sociodemographics, dementia-related knowledge and prevention beliefs as well as health promoting lifestyle level of 1 202 Chinese adults using a self-developed electronic questionnaire〔consisting of general information questionnaire, dementia prevention knowledge questionnaire (DPKQ), Chinese version of the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR) scale, and Chinese version of the revised Health Promoting Lifestyle ProfileⅡ (HPLP-Ⅱ R) 〕from February to March 2020. Multiple linear regression was used to analyze the effect of dementia prevention beliefs on health-promoting lifestyle.

Results

A total of 1 201 cases returned responsive questionnaires, with a response rate of 99.92%. The average score of DPKQ of the respondents was (7.46±2.85), and the rate of correctly answering the questions in DPKQ was 67.82%. The average total score and average item score of the MCLHB-DRR in the respondents were (92.67±12.68), and (3.43±0.47), respectively. The average total score of HPLP-Ⅱ R was (100.00±15.81). The HPLP-Ⅱ R scores were affected by five domain scores of the Chinese version of MCLHB-DRR (perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and general health motivation), the total score of DPKQ, living area (rural or urban), education level and the history of contacting with dementia patients.

Conclusion

The health promoting lifestyle of adults is partially affected by partial dimensions of dementia prevention beliefs and some sociodemographic characteristics. Therefore, health care workers can provide preventive interventions for adults to prevent dementia based on the relationship between the health belief model and health-related behaviors.

Construction of a Community-based Physical Activity Intervention Program Promoting Brain Health

LIU Xiao, PENG Yan, ZHANG Jinying, DENG Menghui, GONG De, CHEN Xiaomei, LI Jie, YANG Yanni

2023, 26(13): 1590-1597. DOI: 10.12114/j.issn.1007-9572.2022.0423

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Background

Maintaining brain health is an advanced goal of healthy ageing. As an important intervention to promote brain health and reduce the risk of cognitive impairment, physical activity is highly recommended in the WHO Guidelines on Risk Reduction of Cognitive Decline and Dementia. However, due to the lack of specific guidance on the types of exercise, amount of exercise and intervention methods, it is difficult to carry out physical activity in the community.

Objective

To construct a community-based physical activity intervention program to promote brain health in community-dwelling Chinese residents.

Methods

A draft of Community-based Physical Activity Intervention Program Promoting Brain Health (CPAIPPBH) was developed in December 2021 based on the evidence extracted from studies searched systematically after being screened and assessed in terms of quality by two researchers independently, and review results of our research group. Then from February to March 2022, the draft was revised in accordance with the results of a two-round email-based Delphi survey with 13 experts, and response rate, authority coefficient, Kendall's W, weight of each indicator, and the logical consistency of indicators at all levels were calculated, and finally the formal version was developed.

Results

Altogether, 26 out of the 8 943 searched studies were enrolled, from which 27 pieces of evidence were summarized, involving target group and principles of physical activity, type of physical activity, intensity and time of physical activity, effect and relevant evaluation of physical activity, and considerations for physical activity. The draft CPAIPPBH consisted of 6 primary indicators and 32 secondary indicators. The response rate, authority coefficient, and Kendall's W were 100.0%, 0.940, and 0.257 (χ²=123.386, P<0.001), respectively, for the first round of survey, and were 100.0%, 0.925, and 0.275 (χ²=139.548, P<0.001), respectively, for the second round of survey. The final program includes 7 primary indicators (including target group and principles of physical activity, pre-intervention assessment, form of intervention, type of physical activity, intensity and time of physical activity, effect and relevant evaluation of physical activity, and considerations for physical activity, with corresponding weights of 0.213, 0.213, 0.213, 0.066, 0.116, 0.116, 0.066, respectively) and 33 secondary indicators. The consistency ratios of primary and secondary indicators were all <0.100 0.

Conclusion

The CPAIPPBH developed by us has proven to be scientific and practical, which could be used to guide the management of community-based physical activity interventions for brain health by community medical workers.

Choice of a Healthcare Institution and Associated Factors in Patients with Multimorbidity during the Implementation of Hierarchical Medical System

ZHU Yuqin, JIN Hua, YU Dehua

2023, 26(13): 1598-1604. DOI: 10.12114/j.issn.1007-9572.2022.0457

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Background

It is of great significance to study the choice of a healthcare institution in patients with multimorbidity in China during the implementation of hierarchical medical system since relevant research is still insufficient.

Objective

To study the choice of a healthcare institution and associated factors in patients with multimorbidity in China during the implementation of hierarchical medical system, providing a reference for further implementation of the hierarchical medical system and rational allocation of medical resources.

Methods

A survey using a self-developed questionnaire was conducted with a random sample of patients with multimorbidity who visited the healthcare institutions in Shanghai Yangpu District Central Hospital Medical Consortium〔including Shanghai Yangpu District Central Hospital, and three community health centers (Dinghai, Yanji and Changbai) 〕from June 1, 2019 to January 1, 2020 for collecting their demographics, knowledge related to supportive policies of hierarchical medical system, practical adherence to the policies, willingness to choose a community health center for initial treatment under different controlled conditions of diseases, and considerations when choosing a healthcare institution. Binary Logistic regression was used to analyze the factors influencing the choice of a community health center for initial treatment.

Results

Of the 1 100 cases who attended the survey, 1 072 (97.45%) who responded effectively were finally included, among whom 85.07% (912/1 072) were older people (≥60 years old). 624 cases (58.21%) have a knowledge of hierarchical medical system; 940 cases (87.69%) approved of concepts proposed by hierarchical medical system; 368 cases (34.33%) were well aware of "1+1+1" type of contracted services; 964 cases (89.93%) had signed the contract of "1+1+1" type of contracted services, among whom 44 cases (4.56%) chose non-designated medical institutions for treatment. Patients who were willing to choose a community health center for initial treatment during the stable phase or when having mildly poorly controlled condition accounted for 86.57% (928/1 072) and 85.82% (920/1 072), respectively. The factors considered by patients when choosing a healthcare institution were ranked as follows (from high to low according to the average comprehensive score) : accessibility (5.50 points), level of medical technology (5.13 points), satisfaction with treatment (3.74 points), medical security (3.60 points), medical expenses (2.93 points), and other factors (2.24 points). Binary Logistic regression analysis showed that age and health insurance were independent influencing factors for the choice of a community health center for initial treatment (P<0.05) .

Conclusion

Older people are at high risk for multimorbidity, and are the major group seeking first treatment in primary care. Compared to regional medical centers, community health centers are more accessible, which is favorable for these patients seeking first-contact care. To promote the choice of a primary care institution for initial treatment advocated by the hierarchical medical system, it is suggested to accelerate the construction of regional medical consortiums, promote the sharing of various high-quality resources and the allocation of such resources to primary care, and improve service quality and capacity of primary care.

Prevalence and Associated Factors of Potentially Inappropriate Medication in Community-dwelling Older Adults in China: a Meta-analysis

LUO Yachan, KONG Lingna, LYU Qiong, YAO Haiyan

2023, 26(13): 1605-1612. DOI: 10.12114/j.issn.1007-9572.2022.0781

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Background

As population aging progresses, the prevalence of multimorbidity and polypharmacy is increasing in older adults, which may increase the risk of potentially inappropriate medication, causing adverse health outcomes.

Objective

To systematically assess the prevalence and associated factors of potentially inappropriate medication in community-dwelling Chinese older adults, in order to provide a reference for developing relevant intervention strategies.

Methods

In June 2022, we searched databases of CNKI, CQVIP, Wanfang Data, SinoMed, PubMed, EmBase, and Web of Science from inception to June 2022 for studies on potentially inappropriate medication in community-dwelling older adults in China. Two reviewers independently selected studies, extracted data and assessed the quality of included studies according to the Agency for Healthcare Research and Quality methodology checklist. Meta-analysis was conducted using Stata 12.0.

Results

A total of 24 studies were included, including two with high quality and 22 with moderate quality. Meta-analysis showed that the pooled prevalence of potentially inappropriate medication was 34.8%〔95%CI (31.3%, 38.3%) 〕in community-dwelling older adults in China. Pooled estimates showed 75 years or above〔OR (95%CI) =1.261 (1.074, 1.481) 〕, five or more comorbidities〔OR (95%CI) =3.287 (1.405, 7.691) 〕, and taking five or more medications〔OR (95%CI) =1.800 (1.305, 2.481) 〕or taking 10 or more medications〔OR (95%CI) =4.380 (2.612, 7.347) 〕were associated factors of potentially inappropriate medication.

Conclusion

Potentially inappropriate medication is common in community-dwelling older adults in China, whose risk is associated with older age, multimorbidity and polypharmacy. Prevention and management of potentially inappropriate medication should be paid attention to individuals with the above characteristics.

Development of a Treatment Burden Scale for Elderly Patients with Coexisting Chronic Diseases

BAI Dingxi, GAO Jing, YANG Zhi, WU Chenxi

2023, 26(13): 1613-1620. DOI: 10.12114/j.issn.1007-9572.2022.0763

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Background

The treatment burden of elderly patients with coexisting chronic diseases is high. Accurate and effective evaluation of the treatment burden provides a crucial assessment tool for the development of individualized intervention protocol and evaluation of intervention effects. However, there is no localized treatment burden scale for elderly patients with coexisting chronic diseases.

Objective

To develop and test the reliability and validity of the treatment burden scale for elderly patients with coexisting chronic diseases, and provide a suitable assessment tool for scientific evaluation of the effectiveness of interventions for elderly patients with coexisting chronic diseases.

Methods

The item pool for the scale was constructed through literature analysis and patient interviews, and the initial scale was developed through expert consultation. The semantics and best presentation formats of the initial scale items were modified by pretesting. From September to November in 2021, 294 elderly patients with coexisting chronic diseases were selected using convenience sampling method, and items of the initial scale were screened using item analysis and exploratory factor analysis to form a test version of the scale. From November to January in 2022, 316 elderly patients with coexisting chronic diseases were selected using convenience sampling method, and the test version of the scale was scientifically evaluated using reliability, validity, and feasibility to finally form the official version of the scale.

Results

The official version of the treatment burden scale for elderly patients with coexisting chronic diseases included 33 items in 7 dimensions, including economic burden, burden of self-management, burden of access to healthcare, burden of medication management, burden of adverse drug reactions, burden of sociability, and psychological burden. The results of the confirmatory factor analysis showed that χ²/df=1.506, comparative fit index (CFI) =0.933, Tucker-Lewis index (TLI) =0.925, standardized residual mean root (SRMR) =0.054, and root-mean-square error of approximation (RMSEA) =0.040. The Cronbach's α coefficient for the total scale was 0.895, the split-half reliability was 0.938, and the retest reliability was 0.939 (P<0.01). The item-level content validity index (I-CVI) was 0.833~1.000, the scale-level content validity index (S-CVI/Ave) was 0.939, the correlation coefficient between the scale items and each dimension ranged from 0.522 to 0.897 (P<0.01). The results of the feasibility test showed that the recovery rate of the scale was 95.8%, the completion rate was 100.0%, and the completion time was 10-15 minutes.

Conclusion

The treatment burden scale for elderly patients with coexisting chronic diseases developed in this study has good reliability and validity, which is suitable for assessing the treatment burden of elderly patients with coexisting chronic diseases in China.

Cost Accounting in Community Healthcare Institutions: Characteristics, Development and Appropriate Methods

ZHAO Liying, LOU Cuidi, LI Yuan, CHENG Wei

2023, 26(13): 1621-1626. DOI: 10.12114/j.issn.1007-9572.2022.0369

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There is no consistent, standardized cost accounting method for community healthcare institutions. The cost accounting in community healthcare institutions differ from that in public hospitals in that these institutions have a wider scope of function orientation, more difficulties in counting volume of services, higher demand for calculating the cost of new services, and relatively weaker informatization foundation, so it is necessary to explore a cost accounting method that is different from that used in public hospitals, and specially applicable to community healthcare institutions. We reviewed relevant literature, then summarized the development of cost accounting in community healthcare institutions, and systematically analyzed four common methods (proportionality coefficient, operating method, equivalent method, standardized workload method) and compared the similarities, differences and applicability of them. We found that the equivalent method and the standardized workload method are more widely used in practice because both of them are simple with "time" as the main accounting parameter, and can quickly calculate the cost of new services. Moreover, the two methods provide a unified "yardstick", which can provide a basis for performance management, financial compensation and personnel supplement for community healthcare institutions. So these two methods can be used for calculating performance and cost basis for community healthcare institutions obtaining the financial security (the first class public welfare institutions), and for those using a performance management system (the second class public welfare institutions), and are more applicable to community healthcare institutions at present. Standards and norms for cost accounting and management in community healthcare institutions should be formed to improve the self-management ability of these institutions and promote the overall high-quality development of community health services.

The Application of Equivalent Method for Cost Accounting and Performance Management in Community Healthcare Institutions

ZHAO Liying, WANG Wei, LI Yuan, LOU Cuidi, CHENG Wei

2023, 26(13): 1627-1633. DOI: 10.12114/j.issn.1007-9572.2022.0422

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Background

During the promotion of category-based management for community healthcare institutions (class 1 institutions obtain the financial security, and class 2 institutions implement a performance management system), how to appropriately determine the security level and scientifically evaluate the performance is a difficulty to tackle for health administrative departments.

Objective

To assess the operational efficiency of community healthcare institutions with the data envelopment analysis (DEA) using the information of costs of these institutions calculated using the equivalent method, then attempt to develop an input and management model of integrating cost accounting and performance management for these institutions, providing a theoretical basis for accurate and scientific input of various resources into the community through cost measurement with equivalent method, and a data basis for performance assessment in communities with different characteristics through efficiency evaluation.

Methods

The real data (financial status and staffing) of 14 community healthcare institutions during 2019 to 2020 were collected from their financial reports, hospital information system, maternal and child healthcare information system, chronic disease management information system, as well as focus group interviews. The equivalent method was used to calculate the total costs of medical services and public health services. The super-efficiency DEA was used to evaluate and analyze the operational efficiency of the 14 sample institutions.

Results

(1) The average cost of one equivalent service (a general medical outpatient service lasting for 15 minutes was defined as one standard service equivalent unit) was 67.64 yuan in 2019 and 69.80 yuan in 2020 for the 14 institutions. The average cost of one equivalent essential medical service was higher than that of one equivalent public health service in both 2019 (167.14 yuan vs 18.86 yuan) and 2020 (215.43 yuan vs 19.78 yuan). The institutions demonstrated significant differences in the average cost of one equivalent essential medical service and the average cost of one equivalent public health service. (2) Each institution had its own peculiar characteristics. For example, S1 institution mainly provided essential medical services, and had higher total equivalent essential medical services and efficiency than other institutions, while S9 institution focused on providing public health services, and had the highest efficiency in delivering public health services. (3) In 2020, the 14 institutions provided 134 800 equivalent COVID-19-related services, with a cost of 1.037 8 million yuan. (4) In 2019 and 2020, only two institutions were relatively overall efficient, and ≥50.0% institutions were pure technically efficient. The institutions with overall operational inefficiency were mainly caused by scale inefficiency primarily due to increasing returns to scale.

Conclusion

The equivalent method provides a relatively unified "scale" to standardize the service efficiency of different types of community healthcare institutions, provides support for health administrative departments implementing category-based compensation for the institutions, benefiting the featured and high-level development of community healthcare institutions. Either institutions delivering essential medical services or those delivering public health services, mainly present increasing returns to scale, suggesting that the efficiency of these institutions can be improved by increasing the human/financial/material input into the institutions and providing precise compensation for them.

Construction and Evaluation of Financial Compensation Model for Government-run Community Health Service Institutions Based on Equivalent Method

LOU Cuidi, ZHAO Liying, CHENG Wei, LI Yuan, AN Xuzhao, XU Xunhang

2023, 26(13): 1634-1640. DOI: 10.12114/j.issn.1007-9572.2022.0400

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Background

With the deepening of the new medical reform, the "short slabs" of the current financial compensation mechanism for primary care institutions has been gradually revealed. Compensation mechanism still needs to be further improved for the existence of painful and difficult problems such as insufficient "endogenous power" of primary care institutions, low efficiency in the use of financial funds, and the compensation mechanism still needs to be improved.

Objective

To explore and establish a service output, more simple and easy-to-use, scientific and reasonable financial compensation calculation model based on equivalent method, so as to provide a reference for the financial compensation of government-run community health service institutions.

Methods

Based on the cost calculation of the equivalent method, the policy analysis and literature review method were used to sort out the financial compensation policies, and the important parameters of the model were determined through expert consultation to build the financial compensation calculation model and financial compensation budget model. The application effect of the model was further evaluated by calculating the financial compensation of 14 community health care institutions in Beijing from 2019 to 2021.

Results

The constructed financial compensation calculation model was mainly composed of three parts, including service equivalent (D), compensation standard per equivalent (P_G) and adjustment coefficient (T), the financial compensation budget model was built on this basis. 14 institutions were taken as examples to calculate the financial compensation, the average calculated financial compensation amount of each institution in 2021 was 45.961 0 million yuan, and the average actual subsidy income of each institution was 44.546 8 million yuan, slightly lower than the calculated financial compensation amount. The average budgeted service equivalent for the 14 institutions in 2022 was 1 139 900 000 equivalents and the average budgeted financial compensation was 50.234 3 million yuan.

Conclusion

The data source of financial compensation calculation model based on equivalent method is standardized and easily available, which is convenient for promotion and use. It was suggested to explore a new model of financial compensation and flexibly use the adjustment coefficients, so that the financial compensation model can better meet the needs of high-quality development.

Standardized Workload-based Analysis of the Services Delivered by a Family Doctor Team in a Community Health Institution

XU Jiayu, YAN Hua, FANG Junbo, WANG Haiqin, GUO Pei, SHEN Fulai, WANG Xingsong

2023, 26(13): 1641-1647. DOI: 10.12114/j.issn.1007-9572.2022.0421

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Background

Problems existing in the operation of a family doctor team, such as unclear work content, inappropriate division of labor, and assigning a team member to a position below his true potential, restrict the overall development of the family doctor team.

Objective

To perform a standardized workload-based analysis of the services delivered by the family doctor team in a central urban community health institution in Shanghai, to understand the major factors associated with the development of the family doctor team, and to provide guidance for the improvement of the work pattern of the team.

Methods

The family doctor team of Xietu Subdistrict Community Health Center, Xuhui District, Shanghai was selected during July to Novermber 2021. The service projects, parameters of standardized workload and the number of services carried out by the team between August and September 2019, and between August and September 2021 were collected, respectively. The team services were analyzed from three aspects: 1. dividing the team services into essential medical services and public health services according to the nature of the service items, then calculating the total amount of standardized workload and total time used in performing the two kinds of services; 2. dividing the team services into five parts (involving community-based mobilization, screening, diagnosis, intervention and follow-up) according to the idea of integration of medical and preventive services, then calculating the total amount of standardized workload and total time used in performing each part; 3. using the TOPSIS method to comprehensively evaluate the value of all service items included in community-based mobilization, screening and follow-up.

Results

The standardized workload of the team in delivering public health services increased to 16 961 in August 2021 from 11 486 in August 2019, and increased to 18 089 in September 2021 from 10 433 in September 2019, demonstrating an average increase of 59.9%. Pearson correlation analysis showed that the standardized workload involved in delivering essential medical services had no correlation with that involved in delivering public health services (r=-0.72, P=0.27). The total amount of standardized workload of the five parts of community health work was ranked as follows in a descending order: community-based diagnosis, community-based follow-up, community-based intervention, community-based mobilization, and community-based screening. The total standardized workload and total time used of the latter three were relatively less. According to TOPSIS evaluation results, 13 projects such as updating health records of patients with chronic diseases, follow-up management of patients with hypertension or diabetes, and information maintenance of contracted residents can be considered to be outsourced or to reduce the execution labor cost.

Conclusion

The family doctor team has not yet formed an effective work model to deliver integrated medical and preventive services, which leads to excessive waste of human resources in the implementation of public health services that need not to be performed by family doctors, affecting the delivery of essential medical services. It is suggested to strengthen the training of professional skills related to community-based interventions for family doctors, and increase relevant facilities and equipment, optimize the allocation of human resources in all parts of community health work, mainly reducing the implementation cost of community-based mobilization, screening and follow-up.

Research Progress on Quality Evaluation of Chronic Disease Management in General Practice

WANG Feiyue, LU Xiaoqin, JIN Guanghui

2023, 26(13): 1648-1654. DOI: 10.12114/j.issn.1007-9572.2022.0572

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Chronic diseases have become a major problem affecting the health of residents in China and globally. The improvement of the quality of general practice is of great significance to improving the management of chronic diseases in primary care. It is an important way to achieve continuous quality improvement by evaluating the quality of chronic disease management in general practice to identify the current problems. According to the review of current status of domestic and international research, some countries have established relatively complete quality evaluation systems for the management of chronic diseases in general practice. Compared with foreign countries, the practice of quality evaluation and improvement of chronic disease management in general practice in China is still in the exploratory stage, although some progress has been made, there are also some challenges: firstly, the quality evaluation of chronic disease management is mainly focused on hypertension and diabetes, insufficient attention has been paid to the clinical quality of other chronic diseases, and the degree of refinement of clinical indicators still needs to be further strengthened compared with foreign countries. Secondly, there are limitations in evaluating the practice process of chronic disease management in general practice, most of the researches were mainly limited to the performance indicators within the framework of services specification. It is possible to refine the evidence-based quality evaluation and quality improvement systems and specify monitoring indicators. Thirdly, there is still a big gap in the construction of information system in general practice, the "fragmentation" and lack of information have seriously hindered the effective evaluation of the quality of chronic disease management, the information system construction should be improved as soon as possible. Fourthly, quality evaluation results focus on feedback within the administrative system and health service providers lack awareness of their own service quality, more equitable and effective evaluation and feedback mechanisms should be explored to promote continuous improvement in the quality of chronic disease management.

Comprehensive Geriatric Assessment in Frail Older People: Thoughts on Application

WU Minjie, WU Shenhui, YAN Yuru

2023, 26(13): 1655-1660. DOI: 10.12114/j.issn.1007-9572.2022.0590

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As China enters an ageing society, the number of elderly people is rising sharply, resulting in a continuous increase in the cost and burden of caring for the elderly. Frailty is an important cause of loss of self-care ability and elderly care problems in elderly people, which means that frailty is associated with a decline not only in physiological functions, but in multiple areas as well, such as mental ability and socioeconomic functioning, and is considered an important geriatric syndrome that affects the quality of life of the elderly. Comprehensive Geriatric Assessment (CGA) is a multi-dimensional and multi-disciplinary assessment process or model specifically for elderly patients. As a core tool in geriatric medicine, it uses a multi-dimensional and multi-disciplinary approach to assess the physical condition, functional status, mental health and social environment status of the elderly, and accordingly a treatment plan is developed to maintain and improve the functional status of the elderly and enhance their quality of life to the most extent. However, the use of CGA is not entirely consistent in China and abroad. This paper reviews the existing studies on frailty in the elderly, analyses the advantages and shortcomings of CGA used in frail elderly patients, and finds that interventions for frail patients at home and abroad have been valued increasingly. The development of domestic interventional studies on frailty is still in the initial stage, and most of these studies use a design of a randomized controlled trial with a sample of chronic disease inpatients. In contrast, such studies have been widely carried out abroad, in which CGA has been applied to the management of cancer patients and patients in the perioperative period besides chronic disease patients and frail community-dwelling older people. The frailty status in the elderly can be scientifically and comprehensively assessed by the CGA, and based on which targeted interventions can be implemented to prevent or delay the development of frailty, but it is generally time-consuming, and there are many difficulties in the management of the assessment recipients. In the future, it is necessary to advance the clinical application of CGA, or develop a more rapid, comprehensive and authoritative tool based on CGA for frailty assessment in the elderly, so as to provide comprehensive and personalized medical services and health guidance for frail elderly population through standardised assessment.

Advances in Falls in the Elderly with Hearing Loss

LIU Jiamin, DAI Fumin, ZHAO Yasha, HAN Lin

2023, 26(13): 1661-1666. DOI: 10.12114/j.issn.1007-9572.2022.0860

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The incidence of hearing loss among the elderly is increasing along with the acceleration of global aging. Hearing loss can limit the ability of the elderly to monitor and perceive auditory cues for spatial orientation, resulting in confusion of orientation and increasing the risk of falls. Based on the review of the latest relevant studies, we introduced the epidemiological characteristics of falls in the elderly with hearing loss, described the pathogenesis (including neuropathological mechanism, sensory deprivation mechanism and physical mechanism), summarized the influencing factors (including age, gender, degree of hearing loss, nature of hearing loss, gait performance, and the use of hearing aids), and put forward strategies for the prevention and treatment of falls. We found that the incidence of falls is increasing in the elderly with hearing loss, and its risk grows with the aggravation of hearing loss, age, aging-related hormonal changes (especially in elderly women), the decline in balancing ability and negative emotions. To reduce the incidence of falls to ensure quality of life and safety in elderly people with hearing loss, it is suggested to prevent or treat falls in this group by the use of hearing aids and auditory rehabilitation training, drug therapy, balance assessment and physical exercise, and psychological intervention.

General Practitioner Implements Family Therapy for a Depressed Patient

JIANG Yue, LI Jie

2023, 26(13): 1667-1670. DOI: 10.12114/j.issn.1007-9572.2022.0450

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Family systems theory is a characteristic theory in general practice, which suggests that in the process of diagnosis and management of a patient, besides physiological problems, general practitioners should pay attention to the influence of family factors on the disease development and treatment as well as rehabilitation of the patient. We reported a case of depression treated with family therapy by the general practitioner after analyzing the impact of her family factors using biopsychosocial model and ideas of general medicine, hoping to improve general practitioners' capability of family-based disease management.

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