October 2019, Volume 22，No.28 Abstracts
Author：尹鹏 Source：CGP Published： [08-29] views： 363
Comprehensive Scientific Research Performance Evaluation System for Community Health Centers：a Specificity Analysis-based Optimization Study LIU Qian1，LIU Rui2，HUANG Jiaoling2，3，SHI Jianwei3，CHEN Ning2，YANG Yan1，YANG Sen4，ZHANG Hanzhi4，WANG Zhaoxin2，3*
1.School of Economics and Management，Tongji University，Shanghai 200092，China
2.Tenth People's Hospital of Tongji University，Shanghai 200072，China
3.School of Public Health，Shanghai Jiaotong University School of Medicine，Shanghai 200025，China.
4.Yangpu Hospital，Tongji University School of Medicine，Shanghai 200090，China
*Corresponding author：WANG Zhaoxin，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background The Scientific Research Performance Ranking for Community Health Centers in China released in 2016 and 2018 have sparked huge responses among the communities.The practice and feedback of the scientific research performance ranking demonstrate that it is urgently to dynamically optimize the scientific research performance evaluation system for community health centers（CHCs）．Objective To optimize the comprehensive scientific research performance evaluation system for CHCs based on specific analyzing the system with reference to community-based surveys and experts' revisions，to evaluate the scientific research performance of CHCs more scientifically.Methods On the basis of systematically reviewing the studies about scientific research performance evaluation，and scientific research performance evaluation systems for institutions，as well as brainstorming，the scientific research performance evaluation system for CHCs was optimized preliminarily.Then its two-level indicator system was modified and improved by using the Delphi method and analytic hierarchy process.Results The optimized indicator system includes 4 first-level indicators，20 second-level indicators and 41 third-level indicators.The weights of the indicators were adjusted by using the analytic hierarchy process.Conclusion Dynamic optimization of the indicators in the comprehensive scientific research performance evaluation system for CHCs，and updating and adjusting their weights，are of great significance for scientifically assessing the scientific research performance of CHCs.The optimized system provides basis for the new round evaluation of CHCs' scientific research performance.
【Key words】 Community health center；Scientific research performance；Ranking；Indicator；Optimization
Ranking and Prospect of Scientific Research Capacity of Community Health Service Centers in China（2019） XU Kangjie1，2，YU Dehua3，4，SHI Jianwei4，5，JIN Hua3，4，CHEN Chen6，HUANG Jiaoling5，WANG Hui5，WANG Zhaoxin2，5*
1.School of Economics & Management，Tongji University，Shanghai 200092，China
2.Tenth People's Hospital of Tongji University，Shanghai 200092，China
3.Shanghai General Practice and Community Health Development Research Center，Shanghai 200090，China
4.Yangpu Hospital，Tongji University School of Medicine，Shanghai 200092，China
5.School of Public Health，Shanghai Jiaotong University School of Medicine，Shanghai 200025，China.
6.Shanghai Pengpu New Village Community Health Service Center，Shanghai 200435，China
*Corresponding author：WANG Zhaoxin，Professor，Doctoral supervisor；E-mail：email@example.com
【Abstract】 Background At present，the development of community health service and general practice in China has entered a special period in which rapid development coexists with bottlenecks.The impact of scientific research on community health service centers has been paid more attention.However，the existing empirical research on scientific research capacity evaluation lacks scientific and systematic studies.This study focused on the change of research capacity，realistic demand and policy orientation.Objective To construct a ranking of scientific research capacity of community health service centers in 2019 to reflect their changes and current situation in China in recent years.Methods From December 2018 to March 2019，questionnaires were sent to 500 community health service centers in 31 provinces except Hong Kong，Macao and Taiwan through health committees at all levels and community health associations.The questionnaires were filled out by the research leaders of community health service centers.Analytic hierarchy process was used to construct the evaluation system，from four aspects of scientific research input，scientific research output，scientific research management and scientific research efficiency，so as to obtain the ranking of scientific research capacity of community health service centers in China.Results In 2019，more than 70% of the top 100 community health service centers in the ranking of scientific research capacity were located in Jiangsu，Zhejiang and Shanghai.Per capita research funding and the number of papers published have increased significantly compared with those in last year.The three most progressive community health service centers were located in Shanghai.Conclusion The ranking of scientific research capacity of community health service centers has played a positive role in guidance，but there is a huge gap between regions.The evaluation system used in this study has a high theoretical and practical significance.
【Key words】 Community health center；Scientific research performance；Ranking；Evaluation system
Recognition of the 2019 Comprehensive Scientific Research Performance Evaluation System for Community Health Centers and the Results：a Survey BO Xiaojie1，SHI Jianwei2，HUANG Jiaoling1，2，WANG Zhaoxin1，2，WANG Hui2，GONG Xin1，PAN Ying3，4，SHI Xiaoxiao3，4，LU Yuan3，4，YU Dehua3，4*
1.Tenth People's Hospital of Tongji University，Shanghai 200072，China
2.School of Public Health，Shanghai Jiao Tong University，Shanghai 200025，China
3.Shanghai General Practice and Community Health Development Research Center，Shanghai 200090，China
4.Yangpu Hospital，Tongji University，Shanghai 200090，China
*Corresponding author：YU Dehua，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background The comprehensive scientific research performance evaluation system for community health centers（CHCs） initially developed in 2017 and the scientific research performance ranking of CHCs launched in the same year，have been verified and improved in practice.However，there is no large-scale survey on whether the evaluation system and results have gained subjective recognition from general medicine experts and the evaluated CHCs.Objective To explore the subjective recognition for the 2019 Comprehensive Scientific Research Performance Evaluation System for CHCs and the evaluation results among general medicine experts from CHCs，offering a reference for further optimization and dynamic adjustment of the system.Methods From March to May，2019，a questionnaire survey was conducted among general medicine experts and scholars from representative CHCs participating in the comprehensive scientific research performance evaluation for CHCs.Their subjective recognition for the 2019 evaluation system and subjective ranking of the CHCs were collected.Kappa test was carried out to assess the agreement between the objective ranking results and expert ranking results.Results The survey showed that 71.4% of the respondents gave their approval for the evaluation system.In terms of the ranking of CHCs，high-level consistency of agreement was found between the objective ranking and the subjective ranking by experts from Beijing and Shanghai （Kappa=0.600，Kappa=0.400），while low-level consistency of agreement was identified between the objective ranking and the subjective ranking by experts from Jiangsu and Zhejiang provinces，and the Pearl River Delta （Kappa=0.317，Kappa=0.200）．Conclusion The 2019 evaluation system has gained recognition from general medicine experts and scholars from CHCs to a certain extent.The objective ranking results have obtained wide recognition in some regions，indicating that the evaluation system is practical and feasible，in part，and the evaluation results can be used for reference.
【Key words】 Community scientific research ranking；Evaluation system；Evaluation results；Kappa consistency test
Impact of Collaborative Drug Therapy Management Mechanism on the Utilization Structure of Outpatient Care in Medical Institutions in Shanghai，China：an Interrupted Time Series Analysis TANG Zhenqing1，HE Jiangjiang1，2，TANG Mi1，ZHANG Tianye3，ZHONG Heng3，LI Lili4，WAN Heping5，JIN Chunlin1，YANG Yan1*
1.Shanghai Hygiene and Health Development Research Center/Shanghai Medical Science and Technology Information Institute，Shanghai 200031，China
2.Fudan University，Shanghai 200032，China
3.Shanghai Municipal Health Commission，Shanghai 200125，China
4.Wonders Information Co，Ltd.，Shanghai 201112，China
5.Shanghai Health Promotion Center，Shanghai 200031，China
*Corresponding author：YANG Yan，Research intern；E-mail：email@example.com
【Abstract】 Background In order to attract residents to sign a health service contract with the family doctor，and satisfy their individualized medication needs，on the basis of the National Essential Drug System，Shanghai Municipality Health Commission issued the extended prescription policy，which means that family doctors can prescribe the same drugs（except narcotic drugs and psychotropic substances） prescribed by a higher level medical institution for their contracted residents with the experience of being transferred upward via their appointment if the residents need to use the drugs continually.In this way，a collaborative drug therapy management mechanism of "basic therapy + supplementary therapy" is developed，which aims to improve the convenience of dispensing drugs in the community health center（CHC），reduce the dispensing workload in the clinic of higher level hospitals，and decrease the economic burden of residents and medical insurance funds.Objective The aim of this study was to estimate the impact of collaborative drug therapy management mechanism on the utilization structure of outpatient care in different levels of medical institutions.Methods From Shanghai Community Informatization Platform （Shanghai Community Health Comprehensive Reform Cloud Management Platform），we collected two-year（2016—2017，the period before and after the implementation of extended prescription policy） healthcare data（output indicators included cumulative number of extended prescriptions，cumulative costs of the extended prescribed drugs，types of diseases，successful rate and cycle of dispensing，and outcome indicators included visits in hospitals and CHCs，healthcare costs，number of prescriptions，and costs of drugs） of contracted hypertensive patients who received healthcare services from 243 CHCs in Shanghai during January 2015 to December 2017.Interrupted time series model（ITS） was used to analyze the change trend of aforementioned indictors after （January 2017 was defined as the intervention timing of related policies） the implementation of policy.Results The number of extended prescriptions showed a fast increase between 2016 and 2017.By the end of 2017，the cumulative number of extended prescriptions was more than 0.9 million，and the cumulative costs of extended prescribed drugs were over 19 million yuan.Most extended prescriptions were written for managing chronic diseases，involving a total of 45 types.Most（over 90.00%） drugs were dispensed successfully.The dispensing cycles of all drugs were implemented within 5 days basically，except that the cycles were longer in the initial stage of implementation（from January to March 2016 ） of the policy.Compared with before the implementation of the policies，after the policy intervention，the number of visits，number of prescriptions，therapeutic and treatment costs and costs of medicines for hypertensive patients in secondary and tertiary hospitals showed a downward trend （P value of β3 representing the slope change was less than 0.05）．However，the number of visits，number of prescribing，average cost of per consultation，and average cost of prescribed drugs per visit in CHCs showed no significant changes （P value of β3 representing the slope change was greater than 0.05）．Conclusion Phased evaluation results of the implementation of extended prescription policy and contracted residents' multiple needs of pharmacological treatment show that the implementation of the policy could relieve the stress of secondary and tertiary hospitals in addressing challenges of great number of chronic disease visits，so it can be implemented continuously and be promoted further，and is suggested to be used as an incentive for guiding contracted residents in actively utilizing family doctors services，as a measure for satisfying the rational needs of pharmacological treatment in community-dwelling residents，and for optimizing the order of diagnosis and treatment via guiding residents' seeking healthcare in a scientific way.
【Key words】 Drug prescriptions；Extended prescription；Interrupted time series analysis；Community health services；Essential drug system；Shanghai
Empirical Research on the Per Diem Payment for Hospitalization of Hospice Care in Community Health Service Center WU Yumiao1，PENG Ying2*，LIU Tongyin3，WANG Linan2
1.Changzheng Community Health Service Center，Shanghai 200333，China
2.Shanghai Health Development and Research Center，Shanghai Medical Information Center，Shanghai 200040，China
3.Jiangxi University of Traditional Chinese Medicine，Nanchang 330004，China
*Corresponding author：PENG Ying，Research assistant；E-mail：firstname.lastname@example.org
【Abstract】 Background Hospice care is one of the important livelihood issues，which is related to the life quality of patients，medical value orientation，and social civilization progress.Hospice care inpatient wards have been set in Shanghai since 2012 and "hospice care" has been included in the municipal government's practical projects.And a hospice care model with community health service centers as the main body has been formed at present.Objective To explore the feasibility of paying for per bed day of hospitalization of hospice care in community health service centers and to further promote the continuous development of hospice care by taking Changzheng Community Health Service Center as an example.Methods The homepage information on medical records of discharged patients from hospice care department in Changzheng Community Health Service Center from 2013 to 2017 were collected.A questionnaire was developed for gathering the cost data.A one-week follow-up survey was conducted among physicians，nurses，medical social workers and social volunteers in the department of hospice care.Direct cost per bed day of hospice care was calculated using relevant cost accounting method.Results There were 491 discharged patients from hospice care department in Changzheng Community Health Service Center during 2013 and 2017.Two of them，who were hospitalized for 1 522 days（2017） and 191 days（2014），respectively，were excluded from the analysis and finally included 489 people.There were 435（88.96%） patients with tumor，15（3.07%） with circulation system diseases，12（2.45%） with respiratory system diseases.Length of stay of the 489 discharged patients spread over 0.5 to 89.0 days，with an average of 15.60 days.Medical expense of the 489 discharged patients ranged from 35 yuan to 23 628.56 yuan，with an average of 4 827.29 yuan.Medical expense per bed day of the 489 discharged patients spread over 67.47 yuan to 2 594.96 yuan，with an average of 309.40 yuan.Direct cost per bed day of hospice care in the Changzheng Community Health Service Center in 2017 was 530.05 yuan，including human cost of 309.11 yuan（58.32%），medicine cost of 144.60 yuan（27.28%），depreciation cost of equipment of 25.81 yuan（4.87%），material cost of 22.40 yuan（4.23%），building depreciation of 17.39 yuan（3.28%） and other costs of 10.74 yuan（2.02%）．Conclusion The expenses per diem of inpatient in hospice care department in Changzheng Community Health Service Center are relatively stable，which meets the requirements of per diem payment.
【Key words】 Community health centers；Community health services；Hospice care；Per diem payment；Costs and cost analysis；Shanghai
Studies on Transformation Cases of Chinese and American Medical Service Modes Based on Transformative Learning Collaborative Theory HUANG Yanli*，CAO Peiya，LUO Xiaolu，ZHU Xingyue
Ministry of Science and Information Technology，Wuhou District Hospital Management Service Center，Chengdu 610041，China
*Corresponding author：HUANG Yanli，Associate chief physician；E-mail：email@example.com
【Abstract】 Background The contracted family doctor service mode is the main carrier of medical service after the transformation of primary medical service mode，and it is an important way to develop general practice at the primary level.However，how to promote the contracted family doctor service mode and truly show the connotation of contracted service in practice is an important problem faced by all localities.Objective By comparing two transformative healthcare practices based on the related theory and tools of Transformative Learning Collaborative（TLC） in China and the United States，we aim to explore how to effectively use TLC for promoting new healthcare mode，contracted family doctor service mode，at district/county level in China.Methods From September 2017 to March 2019，the case of transformative contracted family doctor service mode（hereinafter referred to as Wuhou case） in Wuhou District of Chengdu in China and transformative primary medical service mode〔hereinafter referred to as Veterans Health Affairs（VHA）〕 used by People Allied Care Team（PACT）in VHA case were selected.On the basis of typical case study and combined with literature review，structured interview，questionnaire investigation and expert consultation，we analyzed the theoretical support，transformation goals，activity structure，organizational management structure（including organizational management structure in the healthcare system，and TLC architecture and faculty in service mode transformation），performance of participants and the monitoring indexes and effects in the service mode transformation based on the TLC theory，and completion situation of targeted goals in the medical system transformation.Results Both the Chinese and American cases adopted the classic organizational structure and activity organization mode of TLC，and used TLC as the only transformation learning method to achieve good transformation promotion effects in completing the transformation goals of their systems respectively.All the trainees recognized the contribution of TLC to the transformation resources and were able to complete PDSA improvement plan well.However，there were great differences between two cases in the theoretical support，goal setting of transformation and TLC，and management structure.Conclusion TLC plays a clear role in the transformation and promotion of primary medical service mode with various application scenarios.The systematic and professional TLC theory and the foundation of the transition atmosphere are the basis for the successful implementation of service mode transformation based on TLC theory.
【Key words】 Family practice；Family doctor contract service；Transformative learning collaborative；Healthcare transformation；Ability promotion
Intention of Using Internet-based Chronic Disease Management among Community Physicians and Nurses：an Analysis Using the Hierarchical Linear Model HUANG Zhijie1，ZHANG Xuejiao2，CHEN Baoxin2，ZHOU Ya2，WU Maofu2，SUN Zhihui2，YU Xiaocen2，XIAO Qian2，ZHENG Xiaofen2，WANG Jiaji1，CHEN Wenru2，ZHOU Zhiheng1，2*
1.Guangzhou Huali Science and Technology Vocational College，Guangzhou 511325，China
2.Futian Center for Chronic Disease Control，Shenzhen 518048，China
*Corresponding author：ZHOU Zhiheng，Associate professor；E-mail：firstname.lastname@example.org
【Abstract】 Background With the development of Internet-based medical care，Internet-based chronic disease management models have come into being，showing their unique advantages.Related studies have sprung up，among which the intention of using the models in physicians and nurses is rarely involved.Community physicians and nurses are chronic disease managers，understanding their intention of using the chronic disease management model，and associated factors is of great significance for developing the Internet-based chronic disease management model.Objective To explore the intention and associated factors of using Internet-based chronic disease management in community physicians and nurses.Methods This survey was carried out between February and March 2018 with a self-developed questionnaire based on unified theory of acceptance and use of technology （UTAUT）．Participants were 261 physicians and nurses selected by stratified random sampling from 45 community health centers，Shenzhen's Futian District.The hierarchical linear model was used to analyze the factors associated with the intention of using the Internet-based chronic disease management.Results The average total evaluation score for the intention of using the Internet-based chronic disease management was （4.03±0.88） points.The scores of difference in perceived effectiveness （C6，C7） and the usage intention（C25） among medical staffs of different ages were statistically significant （P<0.05）.The scores of perceived usefulness （C3，C5） and the usage intention （C25） among of medical staffs in different academic qualifications were statistically significant （P<0.05）.The scores of differences in perceived effectiveness （C7），personal factors （C23），and the usage intention （C25，C26） among medical staffs in different professional titles were statistically significant （P<0.05）.The scores of perceived risk （C15） and personal factors （C22） among medical staffs in different positions were statistically significant （P<0.05）.The scores of perceived risk （C15，C16） and task technology matching （C20，C21） among medical staffs in different job categories were statistically significant （P<0.05）.There was a statistically significant difference in the perceived risk （C17） scores among the health care professionals in different professional communities （P<0.05）.The scores of perceived risk （C17） among medical staffs in different professions were statistically significant （P<0.05）.Multi-level linear model analysis showed that the positive factors，the traditional method of identity （B3）〔β=0.110，95%CI（-0.041，0.258）〕，perceived usefulness （C3）〔β=0.110，95%CI（0.026，1.930））〕，social influence （C11，C13）〔β=0.165，95%CI（0.065，0.265）；β=0.235，95%CI（0.094，0.403）〕，task-technology fit （C21）〔β=0.182，95%CI（0.084，0.277）〕 and personal factors （C22）〔β=0.454，95%CI（0.258，0.507）〕，affect the usage intention of medical staffs to use the Internet-based chronic disease（P<0.05）.Conclusion Community physicians and nurses universally prefer to use the Internet-based chronic management model.Their intention of use grows with the increase of individual creativity，social impact，level of task-technology fit，perceived usefulness of the Internet-based chronic management model，and self-identification of the traditional management model.
【Key words】 Community health centers；General practitioners；Nursing staff；Computer communication networks；Internet-based；Chronic disease；Disease management；Linear models
Practice and Thinking of Health Management Services Provided by General Practitioners in the Functional Community in Changning District of Shanghai JIANG Ping1*，ZHENG Xing1，BI Fangfang2，WU Qiong1
1.Health Commission of Changning District，Shanghai 200050，China
2.Tianshan Community Health Service Center of Changning District，Shanghai 200051，China
*Corresponding author：JIANG Ping，Associate chief physician；E-mail：email@example.com
【Abstract】 The goal of the Healthy China is to provide people with comprehensive and lifetime health services in a fair and accessible way.In order to improve the basic medical and health services for young and middle-aged population，Changning District has firstly developed well-rounded，continuous and lifetime health management services for the occupational population in functional communities such as commercial buildings in Shanghai for the general practitioners in community health service centers could practice medical services in different sites.Our aim is to provide the convenient and accessible primary medical and health services for the occupational people to improve their health self-management abilities.In addition，we want to encourage enterprises and institutions to pay more attention to the health of their employees and to increase their input in health care.At last，general practitioners should improve their professional skills in providing medical services in order to obtain extra performance-based remuneration while realizing their professional value.
【Key words】 Functional community；Occupational people；General practitioners；Practice in different medical sites；the Healthy China；Medical and health service at grassroots；Health management；Shanghai
Service Quality Evaluation of Community-based TCM Health Management Delivered by the Family Doctor-led Team Using the SERVQUAL Scale HOU Jin*，CAI Liqiang，KANG Jianzhong，TANG Hongwei
Pudong New Area Datuan Community Health Center，Shanghai 201311，China
*Corresponding author：HOU Jin，Associate chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Traditional Chinese medicine（TCM） health management has comprehensive and remarkable effects in the delivery of prevention services，medical and health services，health maintaining and rehabilitation services.TCM treatment should be given full play to their advantages and characteristics，such as simple and convenient to use，verifiable and effective，and TCM health management can be used in delivering family doctor services in practice in an exploratory way.To promote the continuous improvement of service quality，we used the revised SERVQUAL scale to identify community-dwelling residents' needs of TCM health management，and to find the gap between residents' expected services and self-perceived services.Objective To comprehensively assess the quality of self-reported medical services in patients，and community-based health management in residents using the classic SERVQUAL scale，providing support for improving the quality of community-based health management.Methods Participants were selected from the community-dwelling residents receiving TCM health management from Datuan Community Health Center in February 2016.Demographic characteristics，and expected quality，importance assessment，and perceived quality of community-based TCM health management were obtained by a survey using a self-developed questionnaire consisting of demographic part and SERVQUAL scale revised by our research team.Results A total of 350 cases participated in the survey，and all of them（100.0%） gave effective responses to the survey.All the interventions covered in the community-based TCM health management program were numerically rated below 0，and tended to 0，and the corresponding satisfaction percentages were all above 90.The overall quality numerical score and corresponding satisfaction percentage score of the community-based TCM health management program were -0.148 7，96.28，respectively.In terms of domain numerical score of the revised scale，tangibles achieved highest residents' satisfaction，was rated -0.075 0 on average，and the corresponding satisfaction percentage score was 98.12.Cost acceptability achieved lowest residents' satisfaction，was rated -0.199 2 on average，and the corresponding satisfaction percentage score was 95.02.According to the analysis results of quadrant diagram，interventions distributed most in the first quadrant （13 in all） and distributed least in the fourth quadrant （2 in all）． Conclusion The revised SERVQUAL scale provides scientific and objective support for examining the quality of community-based TCM health management.Investigated patients show high satisfaction on the overall service quality of community-based TCM health management offered by the family doctor-led team，especially on the capability for providing committed services in a standardized way，and medical environment.The waiting links for services and cost issues need high-priority actions to improve and optimize.
【Key words】 Administrations（TCM ＆ TCD）；Community health services；Health management；Service quality evaluation；SERVQUAL scale；Family doctor
Effectiveness of Interventions Co-delivered by General Practitioners and Specialists in Populations at High Risk of Ischemic Stroke in the Rural Community ZHU Lifang1，ZHUANG Junpeng2，ZHAO Shuhua3，LI Yuanzhao3，ZHENG Shuping1*
1.Jiading District Jiangqiao Town Community Health Center，Shanghai 201803，China
2.Department of Neurology，Ruijin Hospital（North），Shanghai Jiaotong University School of Medicine，Shanghai 201801，China
3.Jiading District Malu Town Community Health Center，Shanghai 201801，China
*Corresponding author：ZHENG Shuping，Associate chief general physician；E-mail：email@example.com
【Abstract】 Background Stroke interventions are very important for the reducing of stroke incidence in populations at high risk of stroke.Our research team implemented a delivery model of stroke interventions in populations at high risk of stroke in the rural community in a pilot way，namely，interventions co-delivered by general practitioners（GPs） and specialists，in order to improve the diagnostic and therapeutic level of community physicians and the life quality of rural residents.Objective To explore the effectiveness of stroke interventions co-delivered by GPs and specialists in populations at high risk of stoke in the rural community.Methods According to the inclusion criteria，459 residents at high risk of ischemic stroke were randomly selected from Lixin Village（intervention group，n=237） and Pengzhao Village（control group，n=222），Malu Town，Jiading District，Shanghai between March and April，2015.During June 2015 to June 2016，the intervention group received targeted interventions，tracking and follow-up services co-delivered by GPs and specialists based on their own conditions，while the control group received management delivered by GPs in accordance with the diagnostic and therapeutic guidelines.Physical examination and reexamination were conducted in a follow-up in July 2016.Pre- and post-intervention mean total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C），systolic blood pressure（SBP），diastolic blood pressure（DBP） and carotid Doppler ultrasonography results were compared between the groups.For residents who were found with atherosclerotic plaque in two carotid Doppler ultrasonography examinations，pre- and post-intervention atherosclerotic plaque status was compared.Results After intervention，mean TC，LDL-C，SBP and DBP levels of the intervention group were significantly lower than those of the control group（P<0.05）．The differences of carotid Doppler ultrasonography results between the two groups did not meet statistic significance（P>0.05）．58 in the intervention group and 72 in the control group were found with atherosclerotic plaque in pre- and post-intervention carotid Doppler ultrasonography examinations，but the differences in pre- and post-intervention atherosclerotic plaque overall status between the groups were not significant（P>0.05）．The rates of conversion of atherosclerotic plaque from unstable to stable in the intervention group（36.2%） and control group（20.8%） were not significantly different（χ2=3.792，P=0.052）．The rate of conversion of atherosclerotic plaque from stable to unstable in the intervention group （6.9%） was much lower than that of the control group（13.9%）（χ2=4.565，P=0.033）．Conclusion Stroke interventions supervised and managed by GPs and specialists for in populations at high risk of stoke in the rural community，could effective control and reverse the high-risk factors of ischemic stroke，by which the incidence of stroke may be reduced.This delivery model is worth promoting in primary care.
【Key words】 Stroke；Hypoxia-ischemia，brain；High-risk factor；Plaque，atherosclerotic；Combined intervention of community physicians and specialist doctors；Community
"General Practitioner-Specialist" Model in Mastering Inhalation Skills for Patients with Asthma ZHAO Jiayi1，ZHANG Rong2，LI Xia3，HAN Yiping1，2*
1.Department of General Practice，Shanghai Changhai Hospital，Shanghai 200433，China
2.Department of Respiratory，Shanghai Changhai Hospital，Shanghai 200433，China
3.Jing'an District Jiangning Road Community Health Centre，Shanghai 200040，China
*Corresponding author：HAN Yiping，Chief physician，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 Background Asthma is a key component of community chronic disease management.The Global Initiative for Asthma（GINA） noted that inhaled corticosteroids are currently one of the most effective treatments for asthma.However，most patients with asthma can not receive good therapeutic effect due to poor inhalation skills.Objective To explore the application value of "General practitioner-specialist" model in mastering inhalation skills for patients with asthma.Methods A total of 180 patients with asthma who were admitted to the department of respiratory in Shanghai Changhai Hospital were included in the study from January to December 2018.They were randomly divided into control group and test group，each with 90 cases.All patients were treated with inhaler of budesonide formoterol inhalation powder.The control group was given conventional guidance methods to guide how to master inhalation skills and the test group used "General practitioner-specialist" mode.The error in using the inhaled drug（inhalation method error and device operation error） and the correct inhalation skills（correct device operation，inhalation method as inhalation skills） would be recorded after each guidance.Results After the second，third instruction，the error rate of inhalation method in the test group was lower than that in the control group（P<0.05）．The operation error rate of patients in the test group after the second and third instructions was lower than that in the control group（P<0.05）．In the control group，the correct rate of inhalation skills after the second instruction was higher than that after the first instruction（P=0.010）；the correct rate of inhalation skills after the third instruction in the control group was higher than that after the second instruction（P=0.003）．The correct rate of inhalation skills after the second instruction in the test group was higher than that after the first instruction（χ2=27.388，P<0.001）；the correct rate of inhalation skills after the third instruction in the test group was higher than that after the second instruction（χ2=11.262，P=0.001）．The correct rate of inhalation skills in the test group was higher than that in the control group after the second，third，forth instructions（χ2=9.454，P=0.003；χ2=11.262，P=0.001；χ2=5.178，P=0.039）．Conclusion “General practitioner-specialist” model not only has good effect and high efficiency，but also can effectively improve the mastery of inhalation skills.
【Key words】 Asthma；Administration，inhalation；Insufflation；Chronic disease；General practitioner-specialist；Shanghai
Interventional Effect of the Closed-loop Management by Family Physicians Team on Patients with Coronary Heart Disease XU Weigang，PENG Derong*，CHEN Chen，SUN Chaojun，BO Haiyan，FANG Yabei
Pengpu New Estate Community Health Service Center，Jingan District，Shanghai 200435，China
*Corresponding author：PENG Derong，Associate chief physician；E-mail：email@example.com
【Abstract】 Background In the context of hierarchical diagnosis and treatment，the prevention and treatment of coronary heart disease（CHD） as a typical chronic non-communicable disease，requires advanced intervention from specialist departments，and the continuous and standardized management at the community level indispensably.This study preliminarily explored the impact of a new closed-loop management mode collaborated by specialists and family doctors.Objective To construct the closed-loop management team for patients with CHD and to evaluate its intervention effect.Methods From January 2017 to January 2019，a total of 236 patients with CHD were randomly selected through simple random sampling method according to the electronic health records which were signed in the Pengpu New Estate Community Health Service Center of Shanghai.The patients were divided into the control group（n=122） and the study group（n=114） by random number table method.Patients in the control group received routine diagnosis，treatment and managemengt，patients in the study group were managed through the closed-loop management by family physicians team.All the patients were followed up for two years.The scores of Health-promoting Lifestyle ProfileⅡ（HPLPⅡ），CHD Knowledge and Cognition Questionnaire，Self-efficacy for Managing Chronic Disease 6-item Scale（SECD6） before and after 2-year interventionand，and the incidence of major adverse cardiac events（MACEs） during the following up were compared.Results There were no significant differences in the scores of HPLPⅡ，CHD knowledge and cognition questionnaire，and SECD6 between the two groups before intervention（P>0.05）.After the 2-year intervention，the scores of HPLPⅡ，CHD knowledge and cognition questionnaire，and SECD6 were higher in study group than in control group（P<0.05）.Within 2-year follow-up，the incidence of MACEs in the study group was lower than that in the control group〔（1.8%，2/114） vs （8.2%，10/122），P<0.05〕，and the risk of MACEs in control group was about five times higher than that in study group〔95%CI（1.071，23.337）〕.Conclusion The closed-loop management mode by family physicians team could effectively improve the self-management ability，self-efficacy and knowledge level of patients with CHD and it could improve the prognosis of patients.
【Key words】 Coronary disease；Family physicians team；Community health services；Closed-loop management；Combination of general practice and specialty；Self management；Major adverse cardiac events
Community-based Fall Prevention Strategies Evaluation for Primary Osteoporosis in Elderly People YUAN Yuan，LI Bin*
Lujiazui Community Health Center，Shanghai 200120，China
*Corresponding author：LI Bin，Attending physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Evidence shows that more than 62% of low-violence fractures are caused by falls.Patients with osteoporosis（OP） have a higher risk of falls，so strengthening the prevention of falls in them is of great significance.However，there are many studies on in-hospital falls prevention，but few studies on out-of-hospital falls prevention.Objective To evaluate the effectiveness of community-based fall prevention strategies in elderly patients with primary OP.Methods 100 elderly patients with primary OP were selected from Lujiazui Community Health Center from June to December 2016.By use of a random number table，they were evenly divided into the control group and intervention group，receiving 1-year routine outpatient follow-up visits，1-year routine outpatient follow-up visits and comprehensive interventions with community-based fall prevention strategies，respectively.Before and after the intervention，perceptions of OP were assessed by the Osteoporosis Knowledge Test（OKT），balance function was measured by the Berg Balance Scale（BBS），and lower extremity muscle strength was measured by the Motricity Index（MI-L），respectively.The incidence rate of falls during the intervention was counted and compared.Results Compared with the baseline levels，mean OKT score，BBS score and MI-L score increased significantly in both groups after intervention（P<0.05）．Mean OKT score，BBS score and MI-L score were similar in both groups at baseline（P>0.05），but they increased more significantly in the intervention group after intervention（P<0.05）．There were no significant differences in the incidence rates of falls between the two groups during 1-3 months，4-6 months，and 7-9 months of intervention（P>0.05）．During the 10-12 months of intervention，the incidence rate of falls in the intervention group was lower than that of the control group（P<0.05）．Conclusion Comprehensive interventions with community-based fall prevention strategies may improve their understanding level of OP，enhance the balance function and lower limb muscle strength，and effectively reduce the incidence of falls in elderly people with primary OP.So the interventions are worth promoting.
【Key words】 Community anti-fall strategy；Aged；Senile osteoporosis；Awareness rate；Balance function；Lower extremity muscle strength；Fall
Community-based Application of Clinical Assessment Scales in China YING Meike，LI Shuai，REN Wen，REN Jingjing*
Department of General Practice，the First Affiliated Hospital，Zhejiang University，Hangzhou 310003，China
*Corresponding author：REN Jingjing，Chief physician，Master supervisor；E-mail：email@example.com
【Abstract】 With the great support of the government for community health care，realizing homogeneous community healthcare services has become one of the key research contents of general practice.This paper analyzes the current situation of development，application and classification of clinical assessment scales in domestic community healthcare facilities，discusses the limitations and improvement ways of the scales，in order to provide some clues and help for achieving homogeneous community healthcare services.
【Key words】 Clinical scale；Homogeneous medicine；Community health services；Scale evaluation；Scale application
The Ability and Role of General Practitioners in Rare Diseases ZHANG Shimin*，WANG Junxia
Yuetan Community Health Service Center of Fuxing Hospital Affiliated to Capital Medical University，Beijing 100045，China
*Corresponding author：ZHANG Shimin，Economic manager；E-mail：firstname.lastname@example.org
【Abstract】 This paper explores the role of general practitioners（GPs） in the management of rare diseases through the analysis of the problems faced by patients in the course of the diagnosis and treatment of a rare disease case.According to the core competence and characteristics of GPs proposed by WONCA，this paper puts forward that GPs can play an important role not only in the field of the diagnosis and treatment of common and frequently-occurring diseases，but also in the management of all diseases throughout the whole life cycle of human beings.
【Key words】 Rare disease；Histiocytic sarcoma；General practitioners；WONCA；Disease management；Ability；Effect
Survey on the Expectation of General Practice：Community Perspective WU Hengjing1，2，WU Jing3，ZHAO Xinxin1，CHEN Lin1，LIU Hui2，WU Juanli2，LI Jue1*
1.Tongji University School of Medicine，Shanghai 200092，China
2.Daqiao Community Healthcare Center Affiliated to Tongji University School of Medicine（Preparation），Shanghai 200090 China
3.School of Nursing，Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China
*Corresponding author：LI Jue，Professor，Doctoral supervisor；E-mail：email@example.com
【Abstract】 Background The ever increasing health demand in the 21st century have brought significant new challenges to the development of primary health care.Therefore，there is a urgent need for the development and training of high-level general practitioners in order to improve the level of community-based general practice.Objective To understand the current status and expectations of general practice in community health service centers，and to explore strategies for the construction of community-based general practice.Methods A total of 51 general administrators from 10 community health service centers（Dinghai Community Health Service Center，Sanlin Community Health Service Center，Shiquan Community Health Service Center，Anting Community Health Service Center，Daqiao Community Health Service Center，Gonghexin Community Health Service Center，Lujiazui Community Health Service Center，Zhenru Community Health Service Center，Nanxiang Community Health Service Center，Pengpu Community Health Service Center） were surveyed from July to August 2018.Self-designed questionnaires were sent out via e-mail to conduct the survey.The questionnaire mainly included the investment and development expectation of community general practice（clinical medicine，scientific research，teaching staff，international exchange），training and exchange expectation of community-based general practitioners，and expectation of its support platform.Results A total of 51 valid questionnaires were received，with a 100.0% response rate.，Among 51 administrators，37 were administrative leaders and 14 general managers.Investment in scientific research management，international exchange plan，international exchange and the establishment of international exchange platform were all lower than 50% in the actual investment of community-based general practice，whereas the investment in other sectors exceeded 80%.The development expectations of other fields exceeded 80.0% except that the development expectations of international exchanges were about 60%.In terms of clinical training，a total of eight community health service centers have already set up clinical skills training centers or similar centers for general practitioners.In terms of the expectations of clinical training，45（88.2%） managers believed that at least two clinical training sessions should be organized every quarter，and 34（66.7%） managers believed that each training session should be conducted within 1-2 hours.In terms of scientific research management，a total of nine community health service centers have already set up incubation mechanism or platforms for scientific research in order to assist general practitioners in carrying out community based scientific research.In terms of teaching staff and international exchange，a total of nine community health service centers have acquired the management capability of training teachers，but only two have created international exchange programs.According to the survey on the expected exchange channels and time，a total of 21（41.2%） administrators expected the teachers' international exchange channels to be sent by universities，and 31（60.8%） administrators expected international exchange time period to be limited to 2-4 weeks.In terms of the supporting platform for general practice，a total of 35（68.6%） managers hoped that community health service centers can become affiliated to universities or medical colleges.Conclusion Managers in community health service centers generally believed that the actual investment and development of community-based general practice has not reached their expectations，while international exchange programs need to be strengthened.In addition，most managers believed that community health service centers should become affiliated to universities or medical colleges in order to significantly improve the medical level of community health care.Therefore，by combining health needs with development characteristics of community medical care，we should give full play to the advantages of colleges and universities，improve the continuation of medical mechanisms，strengthen the management of scientific research and training，so as to cultivate more high-level talents in general practice.
【Key words】 General practice；Discipline construction；Talent cultivation；Community perspective；Data collection
Practice and Experience of Integrating National Public Health Related Medical Projects into General Practice Training LI Liqi，FENG Mei*，WANG Xiaoxu，MA Ke，LI Xiaojing，QIAO Aichun，WANG Jianhua，JIANG Li，ZHANG Xiaoyang
Shanxi Dayi Hospital，Taiyuan 030032，China
*Corresponding author：FENG Mei，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Based on the research background of how to improve the post competence and speed up the training of grassroots general practitioners（GPs），this paper expounds the concrete methods of integrating related medical projects in the National Basic Public Health Service Standards（standards） into the training of GPs and GPs teaching statf and the experience are also discussed.The training was conducted for GPs,GPs teaching staff,transferred general practitioners and assistant rural general practitioners.After training,GPs and transferred doctors can master the medical knowledge in the Standards skillfully,and GPs teaching staff understand the needs of general practitioners.The authors believe that a sustainable development pattern for the training of GPs is available in Shanxi Province when related medical projects in Standards blend with general practice training，which will accelerate the speed of training qualified GPs to grassroots medical hospitals and effectively regulate the medical practice of GPs in Shanxi Province.It will be conducive to the standardized team construction of GPs and promote the development of general practice in Shanxi Province.
【Key words】 National basic public health service standards；General practice；Teacher training；Shanxi
Practice and Exploration of Integrating Palliative Care into General Medical Education and Training LI Xiaojing，QIAO Aichun，LI Liqi，ZHAI Yanping，FENG Mei*
Shanxi Academy of Medical Sciences/Shanxi Dayi Hospital，Taiyuan 030032，China
*Corresponding author：FENG Mei，Professor，Chief physician；E-mail：email@example.com
【Abstract】 Palliative care is an integral part of general medicine and one of the main things that general practitioners（GPs） need to master.Now，with the increasing population aging in China，the numbers of chronic disease patients and end-stage disease patients are growing，so the importance of palliative care is further highlighted.However，at present，palliative care education is relatively lagging behind in China，and the content of palliative care has not yet been included in The Standardized Training Outline for General Residents（Trial Edition）．We elaborated the specific actions training results taken by Shanxi to integrate palliative care into the training of GPs and general practice teachers，discussed the experiences，and summarized that the integration of palliative care theories into general medical education is a pattern facilitating the sustainable development of GPs training.Moreover，it supplements palliative care knowledge for GPs，further improves the teaching ability and general practice occupational literacy of general practice teachers，enhances the position competencies in GPs，and accelerates the pace of training qualified GPs with comprehensive capabilities using standardized training programs for primary care institutions.We hope that our practice and exploration can offer reference for further palliative care education for GPs in China.
【Key words】 Hospice care；Palliative care；General practitioners；Education，continuing
Competence-oriented Evaluation System for Standardized General Medicine Residency Training JIANG Jingjin1，CHEN Shaohua1，2*
1.The First Affiliated Hospital，Zhejiang University，Hangzhou 310003，China
2.Zhejiang University School of Medicine，Hangzhou 310058，China
*Corresponding author：CHEN Shaohua，Associate chief physician；E-mail：firstname.lastname@example.org
【Abstract】 General medicine residency training is developing rapidly，but there is no unified mode and indices for the evaluation of the effectiveness of the training.According to the training objectives，requirements and rules of the general medicine residency training，we reviewed the methods，purpose，advantages and disadvantages of general medicine residency training evaluation systems commonly used at home and abroad.In view of domestic general practice development status，on the basis of reviewing the ACGME general medicine resident training program，we suggest that a national unified evaluation system for standardized general medicine residency trainings should be developed to all-roundly assess the post-training residents' core competences as GPs from six aspects （professional literacy，professional knowledge and skills，patient care，communication and cooperation，teaching ability，lifelong learning）．By this way，the quality of such trainings can be improved，which in turn contributes to the cultivation of qualified and competent GPs.
【Key words】 General practice；General residents；Inservice training；Process assessment（health care）；Formative assessment；Summative assessment
Effect Evaluation of "Internet +" in the Examiner Training of General Practice Skills Assessment JIANG Jun1*，MIN Han2，XIANG Yuanyue1，HUANG Min2
1.Jiangsu Health Vocational College，Nanjing 210029，China
2.Suzhou Municipal Hospital （East Branch），Suzhou 215000，China
*Corresponding author：JIANG Jun，Associate professor；E-mail：email@example.com
【Abstract】 Background In recent years，with the introduction of documents related to the training and incentive mechanism for general practitioners，the training of general practitioners is becoming more and more important.However，there is still a big gap between the construction level of general practitioner team and the need to deepen medical reform and build a healthy China.Therefore，a number of teachers and assessment teams with strong professional literacy and high level of ability should be trained.It is of great significance to train general practitioners with strong service skills.Objective To explore the feasible mode to effectively improve training by adopting the multimedia teaching mode of "internet +"，and put forward suitable suggestions for standardized training of general medicine courses and teaching staff （including examiners） in Jiangsu province.Methods A total of 226 trainees were selected to participate in the training of examiners for general practice skills assessment in Jiangsu Province from March to April 2018.They were trained by attending "internet + class，internet + score，internet + performance evaluation".Before and after the training，trainees evaluated the training effect （assessment process，assessment items and contents，assessment scoring standards，examiner's responsibilities and tasks，etc.） by themselves.Results After training，the trainees' understanding of assessment process，assessment items and contents，assessment scoring standards，examiner's duties and tasks was higher than those before training （P<0.05）．Among the respondents，55 had previously served as general practice examiner and 158 had no such experience.After training，the trainees who had served as general practitioner before and who had not served as general practitioner before scored higher in understanding of assessment process，assessment items and contents，assessment scoring standards，examiner's duties and tasks （P<0.05）；before training，the trainees who had served as general practice examiners before scored higher on assessment process，assessment items and contents，assessment scoring standards，examiner's duties and tasks than those who had no experience.There was no significant difference in the scores of assessment process，assessment items and contents，assessment scoring standards，examiner's responsibilities and tasks between those who had served as examiners before and those who had not served as general practice examiners after training （P>0.05）．Conclusion The multimedia teaching mode of "internet +" has achieved the desired training effect during the training of examiners of general practice skills assessment.
【Key words】 Teacher training；General practice；Internet +；Educational measurement；Jiangsu Province
Recent Advances in Attractiveness of a Career as a General Practitioner GAN Yong1，YANG Tingting2，YANG Yudi1，LIU Jianxin1，LU Zuxun1*
1.School of Public Health，Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430030，China
2.Department of Nutrition，Henan Provincial People's Hospital，Zhengzhou 450003，China
*Corresponding author：LU Zuxun，Professor，Doctoral supervisor；E-mail：firstname.lastname@example.org
【Abstract】 As the practitioners of general medicine theory and providers of general health services，the quantity and professional quality of general practitioners（GPs）can directly affect the overall service quality of primary healthcare system.So understanding recent advances in the attractiveness of GP career，and identifying its major associated factors are vital for the stabilization of GP workforce building，and for the strengthening of service capacities of primary healthcare institutions.We analyzed the factors in four domains（job satisfaction，job burnout，turnover intention and intention of being a GP）that can produce negative effects on the attractiveness of GP career，hoping to provide evidence for relevant government departments to develop top-level improvement strategies for the attractiveness of this career.
【Key words】 General practitioners；Occupational attractiveness；Burnout；Turnover intention；Root cause analysis
Exploratory Analysis of Competency Indicators for General Practitioners LU Zhimin，LU Ping*
Malu Community Health Service Center of Jiading District，Shanghai 201801，China
*Corresponding author：LU Ping，Associate chief physician；E-mail：email@example.com
【Abstract】 Background General practitioners have diverse posts in community health service centers，but the existing training and evaluation system does not meet the competency requirements of community posts.And the existing research on post competency is difficult to play a practical role in selecting talents for specific posts in the organization because of insufficient subdivision of posts for general practitioners.Objective To explore and analyze the competency indicators of general practitioners in communities，and to provide reference for the selection and training of general practitioners in institutions.Methods From July to October 2018，the government websites such as the National Health Commission and the Shanghai Health Commission were searched from 2010 to 2018，in order to understand the responsibilities and requirements of general practitioners at the policy level.In 5 September 2008 and 29 October 2018，nine representatives of management，general practitioners and general practitioners in other posts from Malu Community Health Center were invited to participate in the group meeting to summarize the specific duties，responsibilities and the actual situation of general practitioners at the policy level by literature review.From July to October 2018，PubMed，Medline （Ovid），CNKI，Wanfang Data Knowledge Service Platform，and Chinese Biomedical Literature Database were searched for documents related to the comprehensive ability and competency of general practitioners.The retrieval time ranged from 2008 to 2018.In November 2018，five general practitioners in Jiading District of Shanghai were invited to participate in one-to-one in-depth interviews.The main contents of the interviews were as follows：What abilities，qualities or personalqualities should a general practitioner possess in order to do the work within the scope of his/her duties? Through analysis and induction，the competency indicators of family doctor posts were formed.Results At present，the duties of family doctor posts in communities were mainly divided into two categories：business category and security category，among which business category could be subdivided into basic medical category，public health category and other category.The post competency of general practitioners was embodied in six aspects：basic medical service ability，public health service ability，humanistic professional ability，interpersonal communication ability，educational learning ability and comprehensive management ability.It specifically involved 14 competency evaluation indicators，including clinical theoretical knowledge，clinical diagnosis and treatment skills，comprehensive medical service ability，preventive service ability，information application ability，health supervision and cooperation，medical humanistic care，professional attitude and quality，communication ability，team cooperation ability，self learning ability，teaching and scientific research ability，resource utilization ability，and team management ability.Conclusion The difference between post responsibility of general practitioners and the policy requirement lies mainly in the security responsibilities in practice，which is due to the need of the institution operation.Fourteen competency indicators of general practitioners' posts in six aspects indicate that community health service institutions need to select and train general practitioners from clinical，communication，management and other aspects.
【Key words】 General practitioners；Post responsibility；Competence；Indicator；Community health services
Research on Motivate Mechanism of Family Doctors Based on Two-factor Theory LIAN Lu，ZOU Murong，HU Dan，CHEN Jiaying*
Institute of Healthy Jiangsu Development，Nanjing Medical University，Nanjing 211166，China
*Corresponding author：CHEN Jiaying，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background The key to improving the team building of family doctors is to improve their work enthusiasm and the scientific and reasonable motivate mechanism is the key to improving their work enthusiasm.Objective To analyze the influencing factors of family doctor team members' work enthusiasm in contracted service's and make recommendations for improving the motivate mechanism for family doctors.Methods From July to September in 2017，287 family doctor team members of 11 community health service centers in Pukou District of Nanjing were surveyed by questionnaire，and eight leaders of community health service centers eight leaders of family doctor team，and four government health administrators were surveyed by structured interview.Guided by the two-factor theory，this paper analyzed the influencing factors of family doctor team members' work enthusiasm from two aspects of hygiene and motivation.Results 276 valid questionnaires were collected，the effective recovery was 96.2%.Main drive factors affecting the enthusiasm of family doctor team members were the policy and institutional design and remuneration levels in terms of hygiene，along with sense of achievement and personal development in terms of motivation.Conclusion A sound and standardized management system and salary system should be established to increase the sense of achievement for family doctor team members.It is necessary to establish a career development platform and improve the incentive mechanism，so as to enhance the work enthusiasm of family doctors.
【Key words】 Contracted family doctor services；Motivate mechanism；Two-factor theory；Mixed research
Barriers for General Practitioner Trainees Becoming Registered General Practitioners：a Survey WANG Ronghua1，3，LI Yuntao2，3，JI Guozhong2，3*，YUAN Qinbo4，LU Xuemei1，AN Jinhui1
1.The Second Clinical Medical School of Nanjing Medical University，Nanjing 210011，China
2.Department of General Practice，the Second Affiliated Hospital of Nanjing Medical University，Nanjing 210011，China
3.General Practice Research Center，Nanjing Medical University，Nanjing 211166，China
4.President Office，Huaiyin Hospital of Huaian City，Huaian 223300，China
*Corresponding author：JI Guozhong，Professor，Master and doctoral supervisor；E-mail：email@example.com
WANG Ronghua and LI Yuntao are co-first authors
【Abstract】 Background In countries with a relatively sound healt