All levels of China gevernment departments have attached importance to community health management services, an important way for disease prevention and resident saveealth improvement, and successively promulgated relevant management policies. However, there is a lack of systematic review and research on the diffusion paths and characteristics of these policies, which are still unclear due to the diversity of promulgating agencies and types of polices.
To explore the process and features of the diffusion of China community health management policies, providing a reference for the formulation and promotion of these kinds of policies.
From June to September 2021, we searched policy documents related to community health management services published from January 1997 to September 2021 in the official websites of all levels of government and health administrative departments, as well as authoritative databases such as PKULAW.com and so on, then quantitatively analyzed the process and features of diffusion of them in terms of four aspects (intensity, breadth, speed, and direction of diffusion) using policy network analysis and keyword analysis by time series.
A total of 1 540 policies related to community health management were retrieved (including 159 central policies and 1 381 local policies) . The development of community health management services in China may be divided into five stages: germination (1997—2004) , formation (2005—2008) , transition (2009—2012) , initial development (2013—2015) and innovation and development (2016—2021) . Policies which were diffused more intensively and widely were promulgated by central agencies of higher administrative levels, and mainly classified as planning, opinions, and laws. The absolute diffusion breadth of the top 10 policies in terms of diffusion intensity exceeded 30, and the absolute diffusion breadth of the top 10 policies in terms of spreading breadth exceeded 20. The diffusion speed of most policies showed a trend of first increasing and then slowing down over time. The diffusion of Chinese medicine health management policies mainly presented parallel diffusion among policy promulgating agencies at the same level, and top-to-bottom diffusion from the central policy promulgating agencies to the local ones.
Through policy diffusion research, we had a comprehensive understanding of the process and characteristics of diffusion of China's community health management policies, and drew a number of conclusions, including the five-stage development of these policies, and the policy diffusion process may be affected by the attributes of the administrative level of the promulgating agencies and types of policies. In addition, the diffusion of these policies could be achieved via multiple paths, with many mechanisms of action such as learning and imitation, with a speed of "first increasing, then slowing down" over time.
The rapid development of informatization in primary care in regions inhabited by ethnic minorities during the 13th Five-Year Plan period (2016—2020) , has laid a foundation for the improvement of the serving capacity of primary care supported by information technologies, but there is a lack of research on information technology and the efficiency of primary care.
To assess the status including effectiveness of informatization in primary care in China asregions inhabited by ethnic minorities, to explore the impact of information technology on improving the efficiency of primary care.
From July to October 2020, 84 primary care institutions in 23 ethnic counties in three autonomous prefectures of Sichuan (Ganzi, Liangshan and Aba) were selected by stratified sampling, and whose directors were invited to complete a self-administered questionnaire survey for understanding the status including effectiveness of informatization in their institutions. Furthermore, the heads of local health committees and directors of primary care institutions in these ethnic counties were invited to attend a group discussion regardingthe setting of departments, service development, status of informatization and settings for information services in primary care institutions.
In terms of software construction, of the 84 primary care institutions, 57 (67.9%) used the public health system, 44 (52.4%) used the family doctor management system, and 25 (29.8%) use the hospital information system. Forty-seven (56.0%) primary care institutions had achieved vertical connectivity with other institutions (mostly regional- and county-level institutions as well as other members in a regional medical consortium) using information technologies, and regional informatization. Institutions that had horizontal connectivity with 69 (74.4%) of the primary care institutions were medical insurance departments. Only 18 (21.4%) institutions had independent information departments, and 34 (41.0%) did not employ information professionals. Lack of information professionals〔64 (76.2%) 〕, insufficient funds〔52 (61.9%) 〕 and weak infrastructure〔51 (60.7%) 〕 were main problems revealed in informatization construction. Institutions with regional informatization, vertical connectivity with other institutions, and the construction of a hospital information platform with electronic medical record system as the core were superior to those without in terms of setting of laboratory and examination departments and provision of traditional Chinese medicine services (P<0.05) . According to the group discussion, the institutions had basically completed the construction of information standardization, with well-equipped hardware facilities, health informatization-derived management efficiencies, such as improved efficiency, increased scope of supervision, refined supervision, scientific decision-making and digital governance, and service potencies, such as increased efficiency, accessibility and quality of services.
Information technology could greatly contribute to the solving of bottleneck during services delivery in primary care in regions inhabited by ethnic minorities, which has promoted the setting of departments and service extension, and improved the accessibility of health services, as well as the innovation in service delivery modes in these institutions. Problems identified in the informatization construction include insufficient investment in informatization operation and maintenance, insufficient application and lack of information professionals. In view of this, it is suggested to strengthen the investment in informatization construction in primary care, establish a standardized and applicable health informatization training mechanism, pay attention to the construction of a health information talent team, and deepen the intelligent application of information technology in primary care services.
During the 13th Five-Year Plan in China, the rapid development of the informatization construction in the primary health of China has greatly promoted the improvement of the service level and quality of the primary health institutions, but there are still deficiencies in some aspects.
To investigate the status of informatization construction of primary health institutions in Jiangsu Province, in order to analyze the existing problems and provide corresponding countermeasures.
From July to October 2020, a stratified random sampling method was used to select 500 primary health institutions from 13 cities in Jiangsu Province to carry out a questionnaire survey. The contents of the questionnaire included the financial planning and fund sources for infomatization construction of the primary health institutions, status of information system construction of hospitals, the informatization of residents' health records, the deployment of informatization staffs, medical information sharing, status of telemedicine and satisfaction to the informationization of the primary health institutions. The vice president of business filled in the questionnaire according to the truth.
A total of 416 valid questionnaires from the primary health institutions were obtained, accounting for 26.5% (416/1 567) of all the primary health institutions in the province. 80.0% (333/416) of the informatization construction of primary health institutions is planned by the county (city, district) government, and 67.3% (280/416) got fund from the government finance. 99.0% (412/416) of the primary health institutions constructed hospital information management system, 92.1% (383/416) constructed outpatient system, 81.7% (340/416) constructed electronic medical record system, 45.0% (187/416) constructed clinical information system, 98.3% (409/416) constructed information system of residents' health records. 31.3% (130/416) of the primary health institutions shared medical information to the patients, 83.9% (349/416) shared the medical information to the community health service station and the village clinics, 14.2% (59/416) shared the medical information to the superior hospitals, 29.1% (121/416) shared the medical information over the county, 4.3% (18/416) shared the medical information over the city. 38.2% (159/416) of the primary health institutions carried out such services as online appointment, ECG or CT diagnosis, and 15.6% (65/416) carried out real-time outpatient service. 81.3% (338/416) of the primary health institutions showed satisfaction to the informatization construction, and the institutions with different types or in different cities showed different satisfaction.
The overall informatization of primary health institutions in Jiangsu is is relatively good, but there are still phenomena such as unbalanced regional development, low level of cross-regional information sharing and lack of popularization of telemedicine, which needs to be further improved.
The Severe Mental Illness Reporting System (SMIRS) has been operated for many years as an important part of mental health monitoring, but its effectiveness needs to be further explored.
To analyze the perceptions of mental health workersfrom municipal-, district- and community-level hospitals in Beijing regarding the importance, main role, effects and problems during the implementation, and improvement measures concerning the SMIRS, providing suggestions facilitating the improvement of the system.
From March to June 2019, a survey was conducted among a convenient sample of 234 mental health workers from municipal-level psychiatric hospitals, and two stratified samples of 397 mental health workers (one sample of 183 cases from district-level psychiatric hospitals, and the other sample of 214 cases from community-level hospitals) , using a questionnaire named Status of the Rule of Mental Health Laws in Beijing for understanding these workers' general information and their perceptions of the SMIRS.
The SMIRS was assessed as "very important" by 56.3% (103/183) of the mental health workers from district-level hospitals and 54.7% (117/214) of those from community-level hospitals, and as "relatively important" by 66.7% (156/234) of those from municipal-level hospitals.The major role of the SMIRS was assessed as "risk warnings for mental illnesses" by 76.9% (180/234) of the mental health workers from municipal-level hospitals and 82.7% (177/214) of those from community-level hospitals, and as facilitating community-based management of mental illnesses by 80.9% (148/183) of those from district-level hospitals. The implementation effectiveness of the SMIRS was evaluated as "relatively good" by 44.4% (104/234) of mental health workers from municipal-level hospitals, 50.3% (92/183) of those from district-level hospitals, and 50.9% (109/214) of those from community-level hospitals. And the number of workers choosing "relatively good" accounted for the highest percentage of the total workers from each kind of hospitals. The major problem during the implementation of the SMIRS was assessed as "involving patient privacy" by 77.8% (182/234) of the mental health workers from municipal-level hospitals, 78.1% (143/183) of those from district-level hospitals, and 83.2% (178/214) of those from community-level hospitals. And the number of workers choosing "involving patient privacy" accounted for the highest percentage of the total workers from each kind of hospitals. "Standardizing the system of information entry, registration, correction, and summary" was chosen as a measure for improving the implementation of the SMIRS by 73.5% (172/234) of the mental health workers from municipal-level hospitals, and 76.6% (164/214) of those from community-level hospitals, while "standardizing the system of information sharing and protection of patients' privacy" was chosen by 68.9% (126/183) of those from district-level hospitals.
The role and implementation effectiveness of the SMIRS have won the approval of mental health workers from municipal-, district- and community-level hospitals. To further improve the implementation of SMIRS with a dual emphasis on risk containment and privacy protection and consideration for patient management services, we put forward the following recommendations: detailing relevant legal provisions; insisting on ensuring patients access to relevant services (including management) , improving the mental health service system, and implementing the essential and major public health service programs; increasing policy publicity to improve the recognition of the system by patients and their families.
