The role of family doctors has become more and more important as people's demand for healthcare increases. However, there are still some problems in the implementation of family doctor contracting service, such as the difficulty of finding suitable family doctors and the difficulty of data sharing.

Develop a GIS-based Family Doctor Contract Service WeChat Mini Program (hereinafter referred to as the WeChat Mini Program), and complete the usability evaluation to provide residents with a faster and more efficient family doctor contracting service, and for the promotion of the application of mHealth technology in family doctor contracting service.

From January to June in 2022 through literature review to understand the residents' demand for family doctor contracting service and the development of WeChat applet; on-site survey of 200 community residents using random sampling method to analyze the residents' demand for WeChat applet; focusing on the design ideas and function orientation of WeChat applet, four focus group interviews were conducted with the residents, family doctors, administrators, and technicians; based on the demand analysis and the development elements, the development elements of WeChat applet were constructed. Four focus group interviews were conducted; based on the demand analysis and design ideas, the development elements of the WeChat applet were constructed. From June to August in 2022, a field survey was conducted on 96 users of the WeChat Mini Program using the System Usability Scale (SUS). Additionally, usability evaluation of the WeChat Mini Program was performed through key informant interviews and expert consultations.

The main needs of residents for WeChat applets included health consultation (78.00%), quick location of nearby family doctors (75.00%), and health science popularization (71.50%). The design scheme of the WeChat applet covered the core functions of path planning and navigation, information query and display, residents' health management, online contracting and renewal, and online consultation; after the trial operation of the WeChat applet, the usability analysis was conducted, and the average score of SUS was (78.62±9.23), suggesting that the WeChat applet was practically operable and easy to learn.

The connotation of family doctor contracting service based on the GIS platform and the use of multifaceted thinking can ensure the scientificity and usability of WeChat applet development.

Hypertension is a major risk factor for cardiovascular disease. Antihypertensive drug therapy should not only consider the characteristics of the patient's blood pressure but also the patient's comorbid conditions. Currently, there is a lack of research on the medication status and influencing factors of hypertensive patients based on family doctor services.

To investigate the current medication status of hypertensive patients who purchased family doctor contract services in Jieshou City, Anhui Province, to describe the association between patient medication behavior and patient characteristics, to explore the influencing factors of medication adjustment, and to analyze the rationality of medication use in primary hypertensive patients.

Using cluster sampling, from July to August 2021, 48 administrative villages were randomly selected from Jieshou City, Anhui. Data on patient characteristics and medication were collected through face-to-face interviews using a self-made questionnaire. According to the "National Guidelines for the Prevention and Management of Hypertension at the Primary Level (2020 Edition) ", the antihypertensive drugs mentioned by patients in the questionnaire were divided into five categories: category A includes angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), category B includes beta-blockers, category C includes calcium channel blockers (CCBs), category D includes diuretics, and category E includes single-pill combination drugs. Blood pressure data uploaded by patients over the past year were obtained from the backend of iFLYTEK's intelligent voice blood pressure monitor to analyze the medication behavior of patients with different characteristics. Multivariate Logistic regression analysis was used to explore the influencing factors of medication adjustment in hypertensive patients. In this study, "combination medication" refers to taking a combination drug or two or more antihypertensive drugs, and "medication adjustment" refers to patients previously taking other antihypertensive drugs.

A total of 3, 005 hypertensive patients were included in this study, including 1 291 males (43.0%) and 1 714 females (57.0%), with an average age of (65.5±9.8) years. The medication rate of hypertension was 79.1%, and the rate of combination medication was 40.2%. Among the 2 376 patients taking antihypertensive drugs, the rates of different types of antihypertensive drugs from high to low were (some patients had combination medication) : category E (39.6%), category C (35.1%), category D (20.3%), category A (20.1%), and category B (3.7%) ; the most frequently taken antihypertensive drug was compound lisinopril (33.7%). For patients with an average annual blood pressure ≥160/100 mmHg, 12.2% and 4.9% still did not take antihypertensive drugs. Patients' combination medication mainly involved category E antihypertensive drugs. For patients with an average annual "diastolic pressure≥100 mmHg" and "with complications", the rates of adjusted category A and C antihypertensive drugs increased relatively more; for patients with an average annual "systolic pressure ≥160 mmHg" and "without complications", the rate of adjusted category E antihypertensive drugs increased relatively more. Multivariate Logistic regression results showed that longer duration of medication (OR=1.042, 95%CI=1.031-1.053, P<0.001), education level above junior high school (OR=1.488, 95%CI=1.195-1.853, P<0.001), combined hyperlipidemia (OR=1.267, 95%CI=1.052-1.525, P=0.013), combined cardiovascular diseases (OR=1.394, 95%CI=1.166-1.667, P<0.001), and combined cerebrovascular diseases (OR=1.258, 95%CI=1.040-1.522, P=0.018) were promoting factors for medication adjustment in patients, while advanced age (OR=0.980, 95%CI=0.971-0.990, P<0.001) was an inhibiting factor for medication adjustment.

The medication rate among rural hypertensive patients in Jieshou City is high, mainly involving category E and C antihypertensive drugs. Longer duration of medication, education level above junior high school, combined hyperlipidemia, combined cardiovascular and cerebrovascular diseases are promoting factors for medication adjustment in patients, while advanced age is an inhibiting factor for medication adjustment.

Primary medical institutions, with the characteristics of comprehensive, continuous, coordinated, convenient and economical, play an important role in the diagnosis and treatment of common and frequently-occurring children's diseases, planned immunization and child health management, and lay a solid foundation for children's health services. It is essential to improve the quality of child health services for children under the management of family doctor contract. There are regional differences in the ability of children's health services at primary institutions in China. Therefore, accurate evaluation of the quality of children's health services at primary institutions is helpful to find problems in time and promote the development of children's health services at a higher level.

To assess the quality of community children's health services for contracted children, analyze the quality problems and optimization strategies, and provide international vision and decision-making reference for further improving the quality.

Taking a district of Chengdu as a typical case, three community health service centers with stronger child health service ability in the district were selected as the sample institutions, and the parents of children contracted by the sample institutions were surveyed with the online questionnaire on the quality of community child health service by using the Chinese version of primary care assessment tool (PCAT) .

Totally, 3 631 parents of contracted children were investigated. The total PCAT score of community child health service quality in the sample centers was (58.72 ± 13.43). The dimensions with relatively high PCAT scores of community child health service quality includes "continuity" "community first consultation (service availability and service use) " and "comprehensive service (service provision) ", while the dimensions "children and family-Centered" "comprehensive (available services) " and "coordination (referral) " had low scores.

It is suggested to strengthen the supply of diagnosis and treatment services for common pediatric diseases in the community, unblock the referral mechanism of Pediatrics, strengthen the awareness of parents of contracted children to be included in the contracted service team to participate in diagnosis and treatment decisions, and pay attention to the health services for children with non local registered residence.

After being completely promoted for less than seven years, China's contracted family doctor service work still faces a number of development problems. The primary obstacle impeding the work of contracted family doctor service is an inadequate guarantee mechanism. There is an urgent need for scientific and reasonable policies on contracted family doctor service to guarantee the effective development of the work.

To quantitatively analyze the textual content of China's contracted family doctor service policies, to explore the focus and shortcomings of the existing policies, and to provide the basis and reference for the development and optimization of the subsequent contracted family doctor service policies.

Policy texts were collected by visiting the official websites of the China government and the National Health Commission of the People's Republic of China on 2023-01-10, and 15 policy texts on contracted family doctor service from 2015—2022 were selected to construct a three-dimensional analytical framework of policy tools-stakeholders-policy strength, to categorize, code, and analyze the policy documents.

Supply-based, demand-based, and environment-based tools accounted for 30.5% (69/226), 19.0% (43/226), and 50.5% (114/226) of the policy tool dimension. Family doctors, contractors, non-contractors, primary medical and health care institutions, hospitals (secondary and above), and the government accounted for 29.2% (123/422), 14.7% (62/422), 9.2% (39/422), 21.3% (90/422), 13.3% (56/422), and 12.3% (52/422) of the stakeholder dimension. The average strength of China's contracted family doctor service policies was 2.2 points. In the cross-dimension of policy tools-stakeholders, the distribution of stakeholders in supply-based and environment-based tools was relatively poor. There were some sub-tools that were absent from the policy tools. In the cross-dimension of policy tools-policy strength, environment-oriented policy instruments were used more often as policy strength increased. In the cross-dimension of stakeholders-policy strength, there were large differences of the policy strength matching scores among various stakeholders. Family doctors had the highest score (311 points) with non-contractors the lowest score (90 points) .

From the perspective of policy tools, policy tools should be allocated rationally, with the weight of use continuously adjusted, the internal structure optimized, and the rationality of the distribution of policy tools among stakeholders improved. From the stakeholder's perspective, all stakeholders should be taken into account, their respective positions need to be clarified, and the demand of the non-contractors should be emphasized. From the perspective of policy strength, the policy supervision and management capacity ought to be strengthened to continuously improve the implementation of the policy of contracted family doctor service.

Contracted family doctor services were implemented as a key action to reform primary care services in China. At present, the coverage of contracting has expanded stably. But the family doctor teams' evaluation of contracted family doctor services is not clear, which also highlights a number of issues that require further improvement in the provision of the services.

To study the contracted family doctor services for family doctor teams and associated factors.

In October 2022, a combination of purposive sampling and stratified cluster sampling was used for selecting family doctor team members from southern, central, northern and eastern Guangxi to participate in a questionnaire survey. The survey was conducted on the included subjects by using the provider version of the Primary Care Assessment Tools (PCAT-PS) , which contains 8 dimensions and 43 items. Multivariate Logistic regression analysis was used to research the influencing factors of family doctor teams' perception of PACT-PS of the services.

A total of 775 valid questionnaires were collected, with a valid response rate of 99.36%. The average score of the PCAT-PS of the family doctor team members was (32.55±3.90) . The dimensions with the relatively high score were family-centeredness and comprehensiveness, but the dimensions of first contact-access and ongoing care of the services had a relatively low-level perception. Multiple linear regression analysis showed that the type of organization, age, professional title, division of team responsibilities and working patterns were the factors that influence the PCAT-PS score of family doctor team members (P<0.05) .

The family doctor team members had an overall good evaluation on contracted family doctor services while differences in the quality of the services among primary health care institutions in urban and rural areas. The working mode of family doctor team has a positive effect on the improvement of contracted family doctor services quality. To further improve the family doctor teams' evaluation of contracted family doctor services, we need to accelerate the construction of family doctor teams with equal emphasis on "quality" and "quantity", explore the path of integrated salary and job development, and create a "government-community-family" shared governance and resource sharing network.

With the aging of the population and changes in the disease spectrum, the incidence of multimorbidity among the elderly remained high, and have become the focus of the family doctor contracting service at the primary level. At present, there are many studies promoting the signing of family doctors from the perspective of increasing "quantity", but there is still a lack of studies on the factors affecting the effectiveness of family doctor contract services for elderly multimorbidity patients after signing from the perspective of improving "quality".

To explore the important influencing factors of satisfaction and usefulness evaluation of elderly multimorbidity patients with family doctor contract services in urban communities of guangdong province, and to provide a basis for future improvement of multimorbidity management services at the grassroots level.

From September to December 2022, elderly patients with multiple chronic conditions in the community of Guangdong Province (Shenzhen, Zhanjiang and Meizhou) were selected by multi-stage stratified whole cluster random sampling method and surveyed by self-administered questionnaire. Multifactorial Logistic regression analysis was used to explore the influencing factors of satisfaction and usefulness evaluation of family doctor contracting services for elderly multimorbidity patients.

A total of 636 valid questionnaires were collected, with effective recovery rate of 99.69% (636/638). There were 624 family doctors who were relatively satisfied/very satisfied, accounting for 98.11%; The service usefulness evaluation of family doctors was slightly helpful/greatly helpful to 625 people, accounting for 98.27%. The results of multivariate Logistic regression analysis showed that patients with general satisfaction of family doctor contract service were taken as reference. Patients with hyperlipidemia (OR=15.203), disease duration <3 years (OR=48 703 577.681), 4 chronic diseases (OR=135.131), and severe dependence on self-care ability (OR=668 738.913) were more likely to make satisfactory evaluations than patients with complete self-care. Patients with annual personal income of ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), >50 000-100 000 yuan (OR<0.001) were less likely to make a satisfactory evaluation than patients with income >100 000-200 000 yuan (P<0.05). Patients aged 65-69 years (OR=12.573) were more likely to be very satisfied than those aged ≥70 years, and those with 4 chronic diseases (OR=135.131) were more likely to be very satisfied than those with 5 or more chronic diseases. The average annual income of individuals was ≤ 30 000 yuan (OR<0.001), >30 000-50 000 yuan (OR<0.001), and some understanding of the disease (OR=0.013) or more understanding (OR=0.035) patients were less likely to give a very satisfactory evaluation (P<0.05). Multivariate Logistic regression analysis of the evaluation of the effectiveness of family doctor contract services by elderly patients with comorbidity of chronic diseases showed that taking the family doctor contract service as not very useful as the dependent variable, patients aged 65-69 years old (OR=28.710) were more likely to make a slightly helpful evaluation than patients aged ≥70 years old. Working patients (OR=0.091) were less likely to give a slightly helpful evaluation than unemployed patients (P<0.05). Patients aged 65 to 69 years (OR=56.795) were more likely to make helpful evaluations than those aged ≥70 years, and patients with chronic heart failure (OR=0.023) were less likely to make helpful evaluations than those without the disease (P<0.05) .

The overall level of satisfaction and usefulness evaluation of family doctors contracted services of elderly multimorbidity patients in urban communities of Guangdong province is relatively high, both above 95%, which is influenced by a combination of factors, including changing the type of chronic disease, annual income, knowledge of the condition, and self-care ability. In the future, we should continue to standardize and improve the connotation of family doctor contracted services, optimize the management mode of key populations such as elderly multimorbidity, improve the satisfaction and sense of gain of patients, so as to ultimately enhance the effectiveness of family doctor contracted services.

The existing family doctor team performance appraisal system is lack of incentive effect, which has hindered the quality development of contracted family doctor services. However, the performance appraisal system based on family doctor teams includes two processes of "primary distribution" and "secondary distribution", which is more capable of mobilizing the work motivation of the family doctor team members. At present, there is a lack of performance evaluation indicator systems for family doctor assistants and public health physicians, although these two groups of people play an important role in the family doctor team.

To construct "secondary distribution" indicator system of family doctor team performance based on contracted service fee, with regard to the roles of family doctor assistants and public health physicians.

The draft of the "secondary distribution" indicator system of family doctor team performance was preliminarily formulated through literature analysis and semi-structured interview. On the basis of the draft, an expert consultation questionnaire was designed, and two rounds of expert consultation were implemented and completed from October 2021 to April 2022 to develop the "secondary distribution" indicator system of family doctor team performance based on contracted service fee was established.

The recovery rates of the two rounds of expert consultation questionnaires was 100.0%. For the secondary distribution system of family doctor assistants and public health physicians, the authority coefficient for the first round of correspondence was 0.742 2 and 0.742 0, respectively. Finally, the "secondary distribution" indicator system of family physician assistants, including 3 first-level and 10 second-level indicators, and the "secondary distribution" indicator system of public health physicians, including 3 first-level and 13 second-level indicators, were constructed.

The final "secondary distribution" indicator system of family physician assistants with 3 primary indicators and 10 secondary indicators and "secondary distribution" indicator system of public health physicians with 3 primary indicators and 13 secondary indicators is logical and scientific to a certain extent, reflecting the labor value of family doctor assistants and public health doctors in the family doctor team in providing contracted services, which is conducive to the special incentive function of contracted service fee and needs to be optimized and improved in the actual assessment in the future.

The family doctor contract service is being vigorously promoted. Compared with the individual performance appraisal scheme, the performance appraisal scheme based on the family doctor team including the two processes of "first distribution" and "secondary distribution" is more capable of mobilizing the work motivation of family doctor team members, thus improving service efficiency and quality.

To develop the "first distribution" indicator system of family doctor team performance based on contract service fee.

The draft of the "first distribution" indicator system of family doctor team performance was preliminarily formulated through literature analysis and semi-structured interviews. On the basis of the draft, an expert consultation questionnaire was designed, and two rounds of expert consultation were implemented and completed from October 2021 to April 2022 to develop the "first distribution" indicator system of family doctor team performance based on contract service fee.

The recovery rate of the two rounds of expert consultation questionnaires was 100.0%. The authority coefficient of the first round of correspondence was 0.761 6, and the Kendall coordination coefficients of the two rounds of consultations were 0.067 (P<0.001) and 0.712 (P<0.001), respectively. Finally, the "first distribution" indicator system of family doctor team performance was finally constructed, including 3 primary indicators and 15 secondary indicators.

The performance allocation system constructed in this study based on contract service fee, which includes three primary indicators (effective contracting, effective service, and effective fee control), has a certain degree of logic and scientificity that reflects the labor value of the contracted service provided by the family doctor team, and is conducive to special incentive effect of the contract service fee.

Since the comprehensive implementation of the contracted family doctor service in 2016, the willingness of residents to have their first contact in primary care has gradually increased, but the effectiveness evaluation of contracted residents' first contact in primary care needs to be further explored.

To understand the current status of contracted residents' first contact evaluation, explore its influencing factors and propose improvement strategies.

A multi-stage stratified random sampling method was used to select 54 community health service institutions/township health centers in three cities in Shandong Province, with a total of 4 000 contracted residents. The first contact dimension questionnaire of the Chinese version of the Primary Care Quality Assessment Scale (PCAT) was used to conduct the survey, comparing the first contact dimension scores of contracted residents with different characteristics and using multiple linear regression to analyse the factors affecting the first contact evaluation of contracted residents.

A total of 3 859 valid questionnaires were collected, with the effective recovery rate of 96.48%. Among them, 2 086 (54.1%) were residents of township health centers and 1 773 (45.9%) were residents of community health centers; the total score of the first contact dimension in the three regions was 3.49, with the highest score being "Is your contracted institution open on Saturdays and Sundays?" (3.74) ; the item with the lowest score was "During non-business hours, if you were sick at night, would your contracted facility have a doctor or nurse available?" (3.05). The results of the multiple linear regression analysis showed that the contracted facility, personal monthly income, education level, marital status, occupation, physical health and diagnosis of chronic disease were the factors influencing the scores of the first contact dimension of contracted residents (P<0.05) .

The first contact evaluation result of contracted residents is good, but there is still a need to strengthen the promotion of family doctor contracting service policy, guide contracted residents to form the concept of primary care, and promote primary care by clarifying the process of non-working day consultations, improving the service supply capacity of primary care institutions, strengthening the construction of the sharing platform of medical institutions, and leveraging the medical insurance system, so as to improve the first contact evaluation of contracted residents.

The number of patients with chronic diseases in the community of China is increasing annually. Family doctor contract service is an important way to promote people's health in China, and long-term family doctor contract will help to improve the continuity of health management and the treatment outcomes. Analyzing patient demand for long-term family doctor contract is critical to the advancement of family medicine services in China.

To investigate the demand for long-term family doctor contract among community patients in Beijing Chaoyang Distrct and analyze its influencing factors, so as to provide a theoretical basis for achieving high quality family medicine services.

Using continuous enrollment, 500 patients who were enrolled in family doctor contract service at Baliqiao community health service center, Taiyanggong community health service center and Jiangtai community health service center in Chaoyang District, Beijing from January 2020 to January 2021 were included as the study subjects and categorized into the agreement group (those willing to sign long-term contracts) and the refusal group (those unwilling to sign long-term contracts). Data on patient demographics, chronic diseases, educational level, income status, medical expenses, health status, distance from home to the community health service center, compliance, living arrangements, and other indicators were collected through online system retrieval of health records and supplemented by questionnaire surveys from January 2020 to January 2021. From January to March 2021, a questionnaire survey was conducted to collect general information, service quality evaluation, and willingness to sign long-term family doctor contracts. The SERVQUAL scale was designed based on literature retrieval, expert consultation, and preliminary open-ended questionnaire survey results to evaluate the quality of family doctor services. Scores were assigned for expected quality, perceived quality, and importance, ranging from 1 to 5. Expectation scores and perception scores were used to calculate the service quality (SQ) score, and the latter was used to correct importance and calculate the corrected SQ (cSQ) score. Multivariate Logistic regression analysis was used to explore the influencing factors of the demand for long-term family doctor contract services.

A total of 500 questionnaires were distributed, and 423 were collected, including WeChat platform (73, 17.2%), offline questionnaire (190, 44.9%) and telephone interview (160, 37.8%), the validity rate was 84.6%. Among the respondents, 283 belonged to the agreement group (66.9%), and 140 belonged to the refusal group (33.1%). The average score for the SERVQUAL scale was -0.54, with perceived and expected average scores of 3.98 and 4.52, respectively. Statistically significant differences were observed in the cSQ scores and average scores for each dimension between the two groups (P<0.05). The results of multivariate Logistic regression analysis showed that distance from home to the community health service center (OR=1.077, 95%CI=1.013-1.145, P=0.018), compliance (OR=0.291, 95%CI=0.137-0.617, P=0.001), living alone (OR=4.132, 95%CI=1.997-8.550, P<0.001), and cSQ (OR=0.983, 95%CI=0.980-0.986, P<0.001) were independent influencing factors for patients' willingness to sign long-term family doctor contracts.

The corrected family doctor service quality, distance from home to community health service center, living arrangements, and compliance are independent factors influencing patients' willingness to sign long-term family doctor contracts. The SERVQUAL scale can effectively evaluate family doctor service quality and aids in developing strategies for improving family doctor services.

Addressing current health challenges requires the integrated and continuous health care services. The collaboration between primary care providers (PCPs) and medical specialists other than general practice is the most common means of achieving this objective. The patterns and effect of collaborative working between different disciplines has a direct impact on the quality of integrated service delivery, which is critical to improving patient health outcomes.

To systematically review the characteristics of studies related to collaboration patterns between PCPs and medical specialists, contents of collaboration patterns and effects reported by the authors by using scoping review methods.

On September 3 in 2022, PubMed, EmBase, Web of Science, CNKI, and Wanfang Data Knowledge Service Platform were searched for literature related to collaboration between PCPs and medical specialists from inception to the date of search. The characteristics of literature, collaboration patterns and effects were extracted. The elemental decomposition of collaboration patterns was performed based on Mulave 'Gearing Up' model and the contents of collaboration patterns were integrated and demonstrated using content analysis method.

A total of 420 relevant papers were included, of which 214 (51.0%) were committed to evaluating the effects of collaboration patterns, but specific contents of collaboration patterns could be extracted from 82 (19.5%) papers. The distinctive characteristics revealed by the extraction of limited information on the details of collaboration patterns included clear and formalized collaboration patterns, evidence-based guidelines/norms support for collaborative service contents, information systems and dedicated coordinators support for the collaboration between PCPs and specialists. Among the 82 papers, a total of 54 (65.9%) papers clearly reported indicators of effect, of which 90.7% (49/54) reported positive impact on service delivery and outcomes, ranging from service provision process, service utilization and health-related outcome indicators, however, higher proportion (90.7%, 49/54) of studies reporting positive effects could not exclude the presence of publication bias.

When collaboration patterns between PCPs and medical specialists other than general practice are implemented in integrated health services, it is necessary to ensure that approaches and contents of collaboration are specified, as well as the focus on the support of information systems and coordinators. Intervention studies related to health system and policy should emphasize describing the details of intervention design and implementation processes. Methodological quality assessment and meta-analysis are necessary to conduct in future studies on this topic.

With the gradual shift in the disease spectrum, chronic non-communicable diseases (hereafter referred to as "chronic diseases") have become a serious threat to health and economic development in China and globally. Due to various pathogenic factors and a long course of disease, patients with chronic diseases often have a chronic disease accumulation state of individuals suffering from two or more chronic diseases at the same time, referred to as multimorbidity. The problem of multimorbidity is becoming increasingly prominent with a younger trend. The effective integration of fragmented and discontinuous health services, which are disease-centered and treatment-based, is of great significance in addressing this problem. This paper reviewed the current research status and development trends of multimorbidity health service integration at home and abroad, and analyzed the shortcomings of the current researches and practices of integrated health care of multimorbidity. It is proposed that constructing a personalized integrated service model centered on patients with multimorbidity and exploring the quantitative evaluation practice of integrated health care of multimorbidity in the real world are the development direction of future research on multimorbidity integrated services, providing reference for realizing the efficient and sustainable integration mechanism of multimorbidity services among medical institutions in China.

Currently, there are many studies on family doctor contracting services from the perspective of residents, but few scholars have conducted studies on the current situation of family doctor team contracting based on the perspective of general practitioners (GPs) .

To understand the current situation of family doctor contracting services in primary health care institutions in Guangdong Province, and explore the factors affecting the contracted number from the perspective of the supplier.

From July 5—31, 2021, GPs in primary health care institutions in Guangdong Province were selected as the study subjects by using a multi-stage stratified cluster sampling method to conduct the survey with a self-designed questionnaire. The contracted number was compared by different GPs and their family doctor team characteristics. A two-level Logistic regression developed by R 4.2.2 software was used to identify influencing factors of contracted number above 2 000.

A valid sample of 3 252 cases in family doctor team with contracted number more than 100 was screened, and the median contracted number was 1 400 (2 499) in 2020. The differences were statistically significant when comparing the contracted number by gender, age, education level, position, employment form, working years, working unit, working area, training acceptance, and annual income, number of team members, population size under jurisdiction, willingness of specialists from medical community to join the team, inpatient bed resources and guidance from superior departments (P<0.05). Zero model fitting showed that contracted number was clustered at the regional level (P<0.05). Two-level Logistic regression model showed that, with master's degree or above as the reference, the contracted number of the team including GPs with college〔OR (95%CI) =2.79 (1.84, 3.74) 〕and secondary/high school〔OR (95%CI) =2.83 (1.80, 3.86) 〕degrees were more likely to be above 2 000; taking no position as reference, the contracted number of the team including unit leaders〔OR (95%CI) =0.66 (0.33, 0.99) 〕was more likely to be above 2 000; taking temporary staff as reference, the contracted number of the team including formal staff〔OR (95%CI) =2.02 (1.53, 2.51) 〕was more likely to be above 2 000; taking the team with size of 3 or less people as reference, the contracted numbers of the teams with size of 4 to 6 people〔OR (95%CI) =1.31 (1.05, 1.57) 〕, 7-10 people〔OR (95%CI) =2.06 (1.75, 2.37) 〕, 11-19 people〔OR (95%CI) =3.67 (3.31, 4.03) 〕and≥20 people〔OR (95%CI) =3.46 (2.74, 4.18) 〕were more likely to be above 2 000; taking population size under jurisdiction at 2 000 or less as reference, the contracted numbers of the team with population size under jurisdiction at 2 001 to 9 999〔OR (95%CI) =2.37 (2.12, 2.62) 〕, 10 000 to 29 999〔OR (95%CI) =2.92 (2.65, 3.19) 〕and more than 30 000〔OR (95%CI) =2.86 (2.55, 3.17) 〕were more likely to be above 2 000; taking condition of having inpatient bed resources as reference, the contracted number of the teams without such resources〔OR (95%CI) =1.38 (1.14, 1.62) 〕was more likely to be above 2 000 (P<0.05) .

The population under jurisdiction and the large number of team members create favorable conditions for contracting; family doctor teams with GPs with positions, inpatient bed resources and high education level have a good understanding of family doctor contracting service policies and control the number of contracted patients better; comparing with temporary staff, GPs team with formal staff may undertake more contracting tasks.

Focusing on primary care is the primary content of health care policies, however, there is a lack of effective measurement tools in practice.

To construct a index system for county health system development focusing on primary care, provide a reference for its monitoring approaches, and perform analysis and presentation with application cases.

In the study conducted from 2021 to 2022, the index system, weights and percentage conversion methods were constructed based on literature review and Delphi method, case application and analysis were conducted based on the data of questionnaire survey, institutional survey and medical insurance collected by baseline survey among residents, patients and medical workers, as well as data of key informant interview, in 2 experimental counties of county health system reform in Guangxi Zhuang Autonomous Region from 2020 to 2022.

The results of Delphi method showed that the authority coefficient of experts was 0.91, the coefficients of variation of two rounds of consultation were 0.14 and 0.13, respectively. The final constructed index system contains 3 domains, 15 dimensions, and 36 indicators, with a comprehensive index calculation method. The results showed that the overall scores for the two counties in Guangxi Zhuang Autonomous Region were 58.62 and 52.57, respectively, both of which were below the current national benchmark (60.00 points) .

Based on the data availability, the index system constructed in this study can be applied to monitor and evaluate county health system to achieve the goal of focusing on primary care, its application may improve visibility and priority of primary care development, facilitate the publish and implementation policies strengthening primary care.

The development of traditional Chinese medicine (TCM) has been listed as a national development strategy with vigorous improvement of TCM service capacity in primary care institutions as the important elements, however, there are few studies on the disease spectrum of TCM in community health service institutions.

To analysis the TCM disease spectrum in outpatient clinics of contracted residents by family doctors in Shenzhen community health service centers (abbreviated as CHSC) and understand the capability of TCM in Shenzhen health centers, thus providing a theoretical basis for promoting the development of TCM in primary care in China.

From May to June 2022, the records of outpatient consultations with treatment cost of 10 Shenzhen CHSCs from 2021-01-01 to 2021-06-30 were extracted by the unified information platform of the Health Commission of Shenzhen Municipality (Hangchuang Community Health Service Center Business System) . The 385 138 records with purpose of TCM treatment, matching diagnosis and treatment costs, first diagnosis can be coded in Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine (TCD) were collected. The disease spectrum was analyzed based on the classification of disease in TCD, mainly involving department categories, specialty system classifications, and TCM disease terms.

A total of 385 138 records of TCM diagnosis and treatment were selected in this study, including 170 077 (44.16%) male cases and 215 061 (55.84%) female cases, with an average age of (36.7±9.4) years. All of the 7 TCD categories of disease spectrum were involved, including internal medicine accounting for 56.98% (219 445 cases) , pediatrics accounting for 20.56% (79 201 cases) , otolaryngology accounting for 12.45% (47 965 cases) , gynecology accounting for 7.95% (30 620 cases) , surgery accounting for 1.51% (5 797 cases) , orthopedics accounting for 0.37% (1 407 cases) and ophthalmology accounting for 0.18% (703 cases) . Apart from the specialty system classifications of tumor diseases, cancer diseases in each category, classifications of middle canthal disease, black eye disease, pupillary disease, traumatic eye disease in Ophthalmology, the disease spectrum involves all specialty system classifications in 7 categories. The cumulative diagnosis and treatment volume of several disease spectrums accounted for 90.00% of the total diagnosis and treatment in each category. The top 5 system diseases in the spectrum included respiratory system diseases accounting for 54.19% (208 701 cases) , musculoskeletal system diseases accounting for 19.05% (73 369 cases) , gynecological system diseases accounting for 7.95% (30 620 cases) , cardiovascular and cerebrovascular system diseases accounting for 7.15% (27 539 cases) , and the digestive system diseases accounting for 4.98% (19 162 cases) . Patients aged <15 years and 15-24 years mainly suffered from diseases related to the respiratory and digestive systems, and the incidence of diseases such as paralysis, dizziness, headache, insomnia, fatigue were increased with the increase of age; cold ranked the first for patients aged below 45 years, the paralysis of muscle and joint pain ranked the first for patients aged above 45 years.

The TCM diseases spectrum in Shenzhen CHSCs is wide, but the categories are relatively concentrated and single, mainly involving internal medicine, concentrating on respiratory system diseases, musculoskeletal system diseases, gynecological system diseases, cardiovascular and cerebrovascular system diseases, and digestive system diseases. It is necessary to strengthen and expand the TCM diagnosis and treatment capabilities in CHSCs to better meet diverse health needs of the residents.

The long-standing dilemma of difficulties in the improvement of primary care in China has led to county-level medical alliances reforms in various regions throughout the country.

To analyze the combination of pathways that contribute to improving the service capabilities of county-level medical alliances, providing a reference for the improvement and promotion of county-level medical alliances.

CNKI and Wanfang Data Knowledge Service Platform were searched by using "county-level medical alliance" "county health care unit" as keywords from 2020-01-01 to 2022-11-26 to obtain 662 related papers, a total of 9 papers and 11 cases were selected in the analysis. Based on literature review and policy analysis, variables including scale of planning and implementation, close organizational structure, collaborative management system, information platform integration, regional resources sharing, medical insurance payment reform, and incentive mechanism design were identified as outcome variables, while the fuzzy set qualitative comparative analysis was used to identify multiple realization pathways for the service capability improvement of county-level medical alliances.

Four combinations of pathways were found to improve the service capability of county-level medical alliances. Pathway S1: planning and implementation scale * close organizational structure * collaborative management system * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S2: close organizational structure * collaborative management system * information platform integration * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S3: smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * non-sharing of regional resources * medical insurance payment reform * incentive mechanism design. Pathway S4: smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * regional resource sharing * medical insurance payment reform * no incentive mechanism design.

The improvement of service capability of county-level medical alliances needs to focus on close organizational structure, establish management system focusing on the collaboration of departments and member institutions, and promote medical insurance payment reform such as total budget management system of medical insurance funds and diagnosis related groups (DRGs) .

Coordinated regional health development aims to optimize resource allocation by constructing a well-structured and functional regional collaborative system to provide continuous medical services, and to leverage the unique features and strengths of medical centers and community health centers within a region via fully integrating resources and sharing information. However, current available systems for assessing coordinated regional health development mainly focus on outcomes, which are relatively non-diversified and unsystematic, thus further research is required to fill this gap.

We aimed to construct an evaluation system for coordinated regional health development, to provide scientific evidence for evaluating the coordinated development capacities of regions.

We collected essential factors related to coordinated regional health development through a literature review and semi-structured interviews, and used them to construct a draft version of the Coordinated Regional Health Development Assessment System (CRHDAS) . Then we selected 19 experts who were familiar with coordinated regional health development (engaging in general medicine, medical education, administrative management, and public health management) from Shanghai to attend two rounds of online combined with offline Delphi questionnaire surveys from December 2020 to March 2021 to determine the weights of the indicators and test the logical consistency of the weights of indicators at each level using Analytic Hierarchy Process. After that, we established the final version of CRHDAS.

The effective response rate and authoritative coefficient were 95.0% and 0.87, respectively, for the first round of survey, and were 100.0% and 0.92, respectively, for the second round of survey. The CRHDAS consists of four first-level indicators (with corresponding weights of 0.387, 0.296, 0.187 and 0.130) , 12 second-level indicators, and 31 third-level indicators. The consistency ratios for the weights of three levels of indicators are <0.100.

The CRHDAS is of high-level scientificity and practicality, which can help identify problems and deficiencies of the collaboration mode between community health centers, providing a theoretical and practical basis for guiding coordinated regional health practice in the future.

The difficulty of getting pediatric services still exists in China. It is a general trend that community health centers (CHCs) provide pediatric services. There are rare studies on the spectrum of pediatric illnesses in CHCs.

To understand the current status of pediatric diagnosis and treatment in Shenzhen's CHCs by analyzing the spectrum of pediatric illnesses treated in clinics, and to analyze the gap between actual practical status with the training contents based on Spectrum of Diseases for Resident Rotation in Pediatric Medicine (hereinafter referred to as Pediatric Training Rules) specified in General Residency Training Rules in the Standardized Training Contents and Standards for Residents (2022 Edition) .

Through checking the outpatient medical records in CHCs in Shenzhen's 10 districts during April to September 2021, pediatric care expenditure data of children〔including babies (<1 year old), toddlers (1-3 years old), preschoolers (4-6 years old), gradeschoolers (7-12 years old) and teens (13-18 years old) stratified by age〕 contracting family doctor services were collected. The actual spectrum of diseases and diagnosis and treatment behaviors were analyzed, and compared with the Pediatric Training Rules to assess the practical application of the contents required to be mastered in the Pediatric Training Rules.

A total of 961 605 children were included, among whom preschoolers accounted for the highest percentage (38.22%, 367 486/961 605), followed by gradeschoolers (27.57%, 265 151/961 605), toddlers (21.90%, 210 621/961 605), teens (8.49%, 81 594/961 605), and babies (3.82%, 36 753/961 605). The top five diseases in the spectrum and diagnosis and treatment behaviors were respiratory diseases, calcium and vitamin supplements, pediatric physical examination and health care, trauma and postoperative dressing change, and skin diseases, accounting for 67.92% of the total diagnostic and therapeutic workload. Younger age was associated with increased concentrated diagnosis and treatment behaviors. Physical examination and health care (27.60%, 10 142/36 753), calcium and vitamin supplements (25.48%, 9 364/36 753) were the main diagnosis and treatment behaviors in babies. Five diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥80% of the total diagnostic and therapeutic workload in babies, while in teens, 13 diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥80% of the total diagnostic and therapeutic workload. Except for babies, respiratory diseases were the primary reason for seeking treatment in children of other age groups. The proportion of workload of trauma treatment and postoperative dressing change was the highest in teens. Except neonatal asphyxia, neonatal pneumonia, poliomyelitis, infantile tetany and viral myocarditis, the pediatric diseases encountered in these CHCs were covered by the disease spectrum required to be mastered in the Pediatric Training Rules, and the top five healthcare & treatments were respiratory disease treatment〔333 172 (34.65%) 〕, pediatric physical examination and health care〔70 703 (7.35%) 〕, acute infectious diseases treatment〔20 893 (2.17%) 〕, infantile diarrhea〔13 622 (1.42%) 〕, and pediatric abdominal pain〔12 526 (1.30%) 〕. The amount of diagnosis and treatment workload for pediatric anemia, pediatric leukemia, rickets, infantile diabetes, malnutrition, neonatal jaundice, nephritis and nephrotic syndrome, infantile epilepsy, simple obesity, and infantile convulsion accounted for less than 1.00% of the total amount, among which pediatric anemia, pediatric leukemia, neonatal jaundice, nephritis and nephrotic syndrome, infantile epilepsy and simple obesity were mainly transferred for treatment or prescribed a laboratory test.

In general, the CHCs provide a large number of pediatric diagnosis and treatment services, but the services for younger children are still insufficient. Pediatric Training Rules focus on internal diseases, and relevant trainings have some differences with the actual diagnosis and treatment services. The treatments for some diseases in the spectrum in the rules are too specialized, and the diseases are less frequently encountered in community settings, and such patients mainly are transferred for treatment or examined using a laboratory test. Therefore, the pediatric rotation in standardized general residency training should be planned as a whole since the disease spectrum includes many diseases rather than only internal diseases, and actions should be made to expand the training content, improve outpatient teaching, and strengthen the training for physicians to improve their abilities in diagnosis and treatment of young children.

In recent years, with the development of mobile medicine and telemedicine technology, health management models such as Internet hospitals, online and offline cooperation have gradually become a development trend. However, the elderly have limitations in the use of "Internet+" technology, which affects the mobile health of the elderly, and develops a remote management model based on family members, helping improve the coverage and efficiency of health management for the elderly.

To construct an "Internet+" family nursing management model for the elderly, focusing on the contracting problem of the elderly in the context of contracted family doctor services.

From June 2020 to February 2021, the "Internet+" family nursing management model for the elderly was preliminarily formulated according to the policies related to the health management of the elderly, combined with domestic and foreign literature research and preliminary basic research. Applying the Delphi method, 15 experts were selected for two rounds of expert consultation, forming the final draft of the "Internet+" family nursing management model for the elderly.

The positive coefficients of the two rounds of expert consultation were 100%, with the authority coefficients of 0.87 for both, and Kendall coordination coefficients of 0.253 and 0.226, respectively (P<0.001) . The final "Internet+" family nursing management model for the elderly consisting of 5 parts, including the service objects, management team members, the selection and training content of family caregivers, implementation method, management content with a total of 46 items was established.

This study focuses on the practical problems of elderly health management, and the "Internet +" family nursing management model constructed for the elderly not only conforms to the development of "Internet+ medical care" technology, but also realizes the participation of the elderly in remote health management, which is scientific and reliable, and can be used as a tool for remote care management of the elderly in the community.

At present, the contracting rate of family doctors in China is high, but there are problems such as low service quality and low service utilization rate.

To comprehensively investigate the current situation of contracting, performance and renewal of family doctor services in Meizhou and Heyuan cities of Guangdong Province, and explore the impact of appointment consultation service on the quality of contract services.

From July to August 2021, 11 districts and counties in Meizhou and Heyuan cities were selected using a multi-stage sampling method, the list of rural health centers that can be investigated was provided by the health bureau of each district (county). The questionnaire was administered through the "questionnaire star" platform to the head of the rural health centers or the directors of public health. The questionnaire was prepared by the Guangdong Internet + Family Doctor Contract Guidance Center, which was called "Guangdong Family Doctor Contract Service Current Situation Questionnaire", including the basic information of the invesgated rural health centers, the current situation and progress of family doctor contract service. Based on the structure-process-outcome (SPO) model, the dependent variables were set as outcome quality indicators (effective contract rate of general population/focused population, number of institutions with difficulty in compliance and low renewal rate) to compare the current situation of family doctor contract service in rural health centers with different appointment consultation service provision capacity. The Logistic regression was used to analyze the impact of appointment consultation service on the outcome quality of contract service.

The median family doctor contract rate of 100 rural health centers for focused population and general population was 69.0% (60.0%, 85.0%) and 31.8% (29.1%, 54.5%), respectively; the number of institutions reaching family doctor contract service coverage target for focused population/general population of 2025 was 42 (42.0%) and 30 (30.0%), respectively. A total of 78 (78.0%) of these 100 rural health centers faced difficulties in compliance implementation, including 38 (90.5%) rural health centers did not provide appointment consultation service; 50 (50.0%) rural health centers had problems with low renewal rates, including 18 (42.9%) of which did not provide appointment consultation service and faced difficulties in compliance implementation. Logistic regression analysis showed that among the health centers reaching the target, there was no effect the providing of appointment consultation service on the contracting rate of family doctors in the focused and general population (P>0.05) ; among the 100 investigeted health centers, the providing of appointment consultation service had a significant effect on the compliance difficulties of the contracted institutions〔OR (95%CI) =0.28 (0.08, 0.98), P<0.05〕; and the providing of appointment consultation service had no effect on the low renewal rate of contracted residents (P>0.05) .

The performance of family doctor contract service in Guangdong Province is closely related to the providing of appointment consultation service by the health cenyers, and it is recommended to enrich the form and content of appointment service in the process of subsequent service, enhance residents' trust and motivation to use the service actively through the Internet + platform "improve efficiency and quality", while injecting motivation for service provision and utilization from both doctors and patients in order to provide continuous and effective integrated medical and health services as well as health management.

It is urgent to improve the effectiveness of contracted family doctor services due to high prevalence of problems such as uninformed contracting, and contracting but making no appointments.

To analyze the mechanism influencing the effectiveness of contracted family doctor services.

From September 2021 to January 2022, in-depth interviews were conducted with 24 family doctors, 8 institutional managers, and 25 contracted residents purposively sampled from Weifang, Heze, and Jinan of Shandong Province, using an interview guide regarding implementation status of relevant policies and their work status, performance distribution and supervision and management, and sense of gain obtained from the contracting and desired services, respectively. The grounded theory using three levels of coding was used to systematically analyze the mechanism affecting the effectiveness of contracted family doctor services.

Through the coding, 90 concepts (such as "residents' weak health awareness"), 24 categories (such as "awareness of the contracting"), and 8 core categories (such as "capacity in primary care") were obtained. A theoretical model of mechanisms influencing the effectiveness of contracted family doctor services was constructed, mainly including the implementation deviation of policies related to contracted family doctor services, capacity of primary care, and characteristics of residents.

The effectiveness of contracted family doctor services is affected by the deviation in implementing relevant policies, the capacity of primary health services and characteristics of residents. Therefore, to improve the effectiveness of these services, it is necessary to optimize the implementation path of relevant policies, improve family doctors' capacities, and improve residents' health literacy level.

There is an issue of mismatch between supply and demand of medical care resources in China. The implementation of contracted family doctor services is an effective measure to address the issue, and to improve the hierarchical diagnosis and treatment system. Therefore, it is urgent to speed up the training and ensure the training quality of general practice workforce.

To develop a comprehensive and systematic general practitioner (GP) competency model after analyzing the concept and structural domains of competencies (including inner competencies) required for GPs to deliver contracted healthcare services, providing insights into the realization of training eligible GPs in terms of quantity and quality, and the improvement of quality and efficiency of contracted services.

From December 2020 to September 2021, we conducted in-depth, semi-structured interviews with 38 GPs from 10 medical institutions in four cities (Zhenjiang, Taizhou and Suzhou in Jiangsu Province, and Foshan in Guangdong Province) , then treated the interview results applying the three-level coding and theoretical saturation used in the grounded theory. After that, we developed a General Practitioner Competency Model.

The model consists of 10 items, which belong to four domains: general care capability, humanistic practice capability, team cooperation capability, learning and development capability. General care capability and learning and development capability belong to external competencies, which represent the external performance and driving force of competencies, and determine the level of competencies of GPs to provide contracted services. Humanistic practice capability and team cooperation capability reflect the internal traits and competencies, which belong to the inner competencies, and determine the potential of GPs to provide contracted services.

The model developed by us is complete and comprehensive, in which the inner competencies of GPs have been fully explored, which may be contributive to the training of GPs delivering contracted services, and to the development of a GP competency assessment system using quantitative empirical methods.

The competencies of general practitioners (GPs) have become a basis for promoting the implementation of tiered diagnosis and treatment, and effective supply of primary healthcare services against the backdrop of the initiation and implementation of contracted services provided by GPs in primary care in China. The regular competency-based assessment systems with clear objectives and strong operability can positively stimulate GPs to provide contracted services with higher quality and efficiency.

To develop a competency rating scale for GPs, providing a tool applicable to scientific evaluation of GPs' competencies in China.

By use of a GP competency model, and review results of relevant studies and competency scales, the measurement items and the draft of the scale were developed, then were revised according to the results of a questionnaire survey conducted with GPs in primary care in major provincial administrative regions from April to August 2021. Among the 402 responders, the answers of 201 cases (sample A) were used for exploratory factor analysis, and those of the other 210 cases (sample B) were used for confirmatory factor analysis. Based on this, the reliability and validity of the final scale were tested.

The final General Practitioner Competency Rating Scale includes four dimensions (general service competency, humanistic competency during practice, teamwork and cooperation competency, learning and development competency) and 21 items. The Cronbach's α for the scale, and the afore-mentioned four dimensions was 0.929, 0.877, 0.850, 0.812, and 0.811, respectively. The P-value of Bartlett's test of sphericity was less than 0.001 (approximate χ²=2 319.759, P<0.001) , reaching a significant standard, and the KMO value (0.923) was close to 1.0. By exploratory factor analysis, four common factors were extracted, explaining 67.680% of the total variance. The first-order confirmatory factor analysis showed that the correlation coefficients of the four dimensions were between 0.68 and 0.72, and highly correlated. The second-order confirmatory factor analysis results were: χ²/df=1.312, RMSEA=0.039, CFI=0.976, GFI=0.913, NFI=0.907.

Our scale has proven to have good reliability and validity, which may be used for assessing the competencies of GPs delivering contracted services in China.

With the continuous progress of the New Medical Reform, contracting service by family physicians has increasingly become an important guarantee for the basic medical care and health of the people, and the agreements of family doctors' contracting service has become the premise of achieving "everyone has a family doctor". However, the standardization and binding force of the agreement still remain to be studied.

By analyzing the agreements of family doctors' contracting services, we expected to further standardize the contracting services and improve the standardized management level of the services contracted by family doctors.

According to the purpose of the survey, the contracting agreements of the 14 community health service centers were finally selected as subjects by random sampling among 1-3 community health service centers in each of the nine main districts of Chongqing in July 2021. The main analysis framework was based on the contracting subject, contracted service, contracting fee mechanism, and the rights and obligations of the contracting subject. Finally, descriptive analysis of the agreements was performed by means of content analysis.

When compared the agreements in different districts, the contents of basic medical services and basic public health services were relatively similar (basic medical services included diagnosis and treatment services for common diseases, frequently occurring diseases and traditional Chinese medicine, etc., and basic public health services included establishing resident health files, providing health consultation, and vaccination, etc.) . There were differences in the terms of years of service, personalized services, etc. among family doctors in different regions of Chongqing: there were 12 agreements that specified a binding period of 1 year, 1 agreement whose duration was decided by the parties, and 1 agreement that did not specify the binding period. Among all agreements, the definition of the rights and obligations of contracting subjects and parties was vague. Among them, contracting subjects of 6 agreements included community health service centers, superior guidance hospitals, family doctors and representatives of heads of households or family representatives, 6 agreements included community health service centers, family doctors and representatives of heads of households or family representatives, 1 agreement included community health service centers and household heads, and 1 agreement did not specify the contracting subject.

It is necessary to further clarify the objects and agreements of contracting service, and improve the rights and obligations of the contracting subjects in Chongqing. Combined the experience of implementation of contracting services by family doctors of various regions, it is necessary to improve the performance effectiveness and the quality of the contracted services, and promote the implementation and development of the family doctors' contracting services.

Population aging is getting worse in our country. Family doctor contract service plays an important role in boosting the construction of hierarchical diagnosis and treatment system and establishing a reasonable and orderly medical order. Current research about family doctor contract service policy mainly focus on qualitative evaluation, and there are few researchers use tools to quantitatively evaluate each individual representative policy.

This study aims to quantitatively evaluate the pros and cons of six Chinese central government policies about family doctor contract service, thus, proposing strategies and measures to promote the high-quality development of our country's family doctor contract service, and helping the construction of healthy China.

We searched Peking University's PKULAW.com and websites of some relevant ministries of the State Council of China from January 1, 2015 to April 30, 2022. The key word was "family doctor". The software ROSTCM 6.0 was used for text mining. Based on the results, this study selected central government policies about family doctor contract services, then used the PMC index model to quantitatively evaluate these policies.

This study included thirty-two policies based on inclusion and exclusion criteria. The top five high-frequency keywords in the field of family doctor services are "contract service" (n=274) , "health" (n=272) , "medical" (n=264) , "family doctor" (n=225) , and "contract" (n=180) . They were marked as P1-P6, respectively. In terms of methods and other aspects, the scores of each dimension are relatively high. The results of quantitative evaluation showed that the ranking of policies is P1>P3>P2>P6>P4>P5. Three policies were rated as excellent, the other three were rated as acceptable. The scores were relatively high in the policy content, policy nature, policy evaluation, policy field and policy role.

Our country's family doctor contract service policy had a relatively broad content and is relatively mature. It is suggested to pay attention to the combination of long-term, medium-term and short-term validity of the policies, improve incentive approaches from multiple perspectives, enhance the sense of professional honor of family doctors, and use a variety of policy tools and policy action.

Since the full implementation of contracted family doctor services in 2016, we have achieved phased results. Further work needs to be paid equal attention to "quality" and "quantity", focusing on improving the residents' sense of service access and satisfaction, however, at present, the residents' evaluation of contracted family doctor services is not clear.

To investigate the contracted residents' evaluation for the continuity of family doctor contract, explore its influencing factors, and propose improvement strategies.

This study used a multi-stage stratified random sampling method to select 1 193 contracted residents from 9 community health service institutions and 9 township health centers in Heze City, Shandong Province in January 2021. A household survey was conducted on the included residents by using the continuity dimension of the Chinese version of the Primary Care Assessment Tools (PCAT) , which contains 15 items. We compared the PCAT-continuity dimension scores of contracted residents with different characteristics, and used multiple linear regression to analyze the factors influencing the PCAT-continuity dimension scores of contracted residents.

A total of 1 098 valid questionnaires were collected, with a valid response rate of 92.04%. 541 (49.27%) of them were contracted to community health service institutions and 557 (50.73%) of them were contracted to township health centers. The average score of the PCAT-continuity dimension of the contracted residents was (3.38±0.51) . The item with the highest score was "Does your family doctor listen to you patiently", with a score of (3.64±0.59) . The item with the lowest score was "Would you be willing to change your family doctor if it was easy to do so", with a score of (2.98±0.92) . Multiple linear regression analysis showed that the type of contract organization, age, education, marital status, occupation, and chronic diseases were the factors that influence the PCAT-continuity dimension score of contracted residents (P<0.05) .

The contracted residents had an overall good evaluation on the continuity of contracted family doctor services, and the long and stable doctor-patient relationship had been established. Township health centers are better than community health service institutions. To further improve the contracted residents' evaluation of contracted family doctor services, we need to pay more attention to the type of contracting institution, the age, education level, marital status, occupation of contracted residents and their chronic diseases.

For building a healthy China, it is essential to expand the coverage of family doctor services. In young and middle-aged office building occupants, the rate of contracting family doctor services is low. Shanghai has taken the lead in exploring building-based family doctor services, and providing on-demand health management services. So it is particularly meaningful to study the health needs in young and middle-aged office building occupants.

To investigate the needs and associated factors of contracted family doctor services among young and middle-aged office building occupants in Shanghai.

A questionnaire survey was conducted from December 2019 to December 2020 with a cluster random sample of young and middle-aged office building occupants (aged 18-59 years) selected from representative office buildings in Shanghai's Hongkou District, Pudong New District, and Jing'an District of Shanghai for understanding their sociodemographic characteristics, health and healthcare-seeking conditions, knowledge of family doctor services, and needs of essential and personalized family doctor services. Multiple Logistic regression analysis was used to analyze the factors affecting the needs of family doctor services.

In all, 2 366 cases attended the survey, and 2 272 of them (96.03%) who completed the survey effectively were included for analysis. Among them, 87.65% (1 874/2 138) had general, moderate or strong needs for essential family doctor services, and 70.59% (1 452/2 057) had needs for personalized family doctor services. Multiple Logistic regression analysis indicated that age, education level, self-assessed social class, understanding of one's own health, self-assessed health status, chronic disease prevalence, mental health status, preferred healthcare setting for treating common diseases, treatment experience in a community health institution, understanding of and degree of trust in a family doctor, and understanding of building-based family doctor services and the specific scope of the services were associated with the needs of essential family doctor services (P<0.05). Education level, social health insurance, commonly used drugs, chronic disease prevalence, preferred healthcare setting for treating common diseases, treatment experience in a community health institution, understanding of building-based family doctor services, and understanding of the scope of building-based family doctor services were associated with the needs of personalized family doctor services (P<0.05) .

The contracted family doctor services were in high demand in young and middle-aged office building occupants. Improving health literacy in this population, modifying publicity strategies regarding the services, and improving the capabilities of the family doctor team and primary medical institutions, may be conducive to increasing the rate of contracting family doctor services in this group.

Shanghai is gradually expanding the supply of family doctor contract service to building functional communities, but the prevalence of met needs of such services in young and middle-aged office building occupants is still unknown, and relevant studies on the prevalence and associated factors could inform the development and improvement of policies regarding building-based family doctor services.

To explore the prevalence of met needs for contracted family doctor services and associated factors in young and middle-aged office building occupants.

A questionnaire survey was implemented from December 2019 to December 2020 in the setting of office buildings selected by typical sampling from Hongkou District, Pudong New District and Jing'an District of Shanghai. Among the young and middle-aged occupants (n=2 272, 18-59 years old) selected from the buildings by use of cluster random sampling to attend the survey, 1 137 with an experience of using contracted family doctor services were determined as the participants. The survey involved four aspects, including sociodemographic and economic characteristics, health status, understanding level of contracted family doctor services, and met needs of these services (containing essential and personalized service needs assessed using a 5-point Likert scale). Multinomial and ordinal Logistic regression was used to analyze factors associated with met needs of contracted family doctor services.

The prevalence of having needs of essential family doctor services considerably/completely met was 39.61% (425/1 073). And that of having needs of personalized family doctor services considerably/completely met was 39.01% (419/1 074). Multinomial and ordinal Logistic regression analysis revealed that registered place of household (Shanghai or not), occupation, annual income, self-rated health, understanding of the "1+1+1" type of contracted family doctor services, level of trust in family doctors, and evaluation of family doctors' service capabilities were associated with met needs of essential family doctor services (P<0.05). Sex, annual income, chronic disease prevalence, understanding of the "1+1+1" type of contracted family doctor services and the composition of a family doctor team, as well as evaluation of family doctors' service capabilities were associated with met needs of personalized family doctor services (P<0.05) .

The prevalence of self-reported met needs of essential or personalized family doctor services in the young and middle-aged office building occupants was about 40%, which was associated with sociodemographic and economic characteristics, health status, understanding level of contracted family doctor services, and self-assessed family doctors' service capabilities. It is recommended to improve the publicity of the system of contracting family doctor services, customize personalized service plans according to the characteristics and differentiated needs of the population, improve the family doctor's service capabilities and enrich the services.

The prevalence of sub-health problems is increasing in young and middle-aged office building occupants, in which the percentage of mental health problems is on the rise. Shanghai took the lead in delivering family doctor services via the health station set in an office building in June 2018, but mental health in young and middle-aged people has not yet been insufficiently covered by the services.

To assess the prevalence of anxiety and influencing factors in young and middle-aged office building occupants in Shanghai.

A questionnaire survey for estimating anxiety prevalence was carried out in typically sampled office buildings from Hongkou District, Pudong New District and Jing'an District of Shanghai during December 2019 to December 2020. Cluster random sampling was used to sample young and middle-aged occupants (18-59 years old) in the buildings, and 2 198 cases of them who completed the survey were included as the participants for analysis. Anxiety was diagnosed by the score of the Zung's Self-Rating Anxiety Scale. Multiple linear regression was used to estimate the association of anxiety prevalence with socio-demographic and economic characteristics, and health status as well as lifestyle.

Among the participants, the prevalence of no anxiety, mild, moderate and severe anxiety was 60.42% (1 328/2 198), 18.61% (409/2 198), 12.46% (274/2 198), and 8.51% (187/2 198), respectively. Multiple linear regression analysis found that registered place of household (Shanghai or not), education level, self-rated social class, self-rated health, frequency of physical examination, level of fatigue, chronic disease prevalence and regular medication were associated with anxiety prevalence (P<0.05) .

The prevalence of anxiety was high in this group of population, which may be associated with the population characteristics. In view of this, mental health should be valued during the delivery of family doctor services for these people, and targeted interventions can be provided according to personal anxiety status when necessary.

In China, team-based service delivery model is a major emerging model for contracted family doctor services, but there is a lack of a tool for assessing the overall effectiveness of the family doctorteam.

To develop a IMOI model-based system for assessing the effectiveness of family doctor teams in Beijing, aiming at proving a tool for guiding the improvement and continuous development of the family doctor team.

The first draft of the Family Doctor Team Effectiveness Evaluation System (FDTEES) was developed using literature review and personal interview. Then the indicators of the system were assessed and revised according to consensuses of our analysis and the results of two rounds of consultations carried out between May and July 2021 using the Delphi technique (one was conducted with 24 experts, and the other with 21 experts) . The weight of the indicators of the system was determined by and analytic network process.

The response rate of experts in the first, and second round of consultation was 87.5% (21/24) , and 100.0% (21/21) , respectively. The authority coefficients for the consultations ranged from 0.88 to 0.91. Kendall's W for the importance and applicability of the indicators of the FDTEES was 0.138 (P<0.001) , and 0.263 (P<0.001) , respectively, in the first round of consultation, was 0.255 (P<0.001) , and 0.257 (P<0.001) , respectively, in the second round of consultation. The final FDTEES consists of 71 indicators, including 7 first-level indicators〔team building (0.155) , quality of team members (0.155) , team member relationship (0.097) , team process (0.141) , team service results (0.155) , perception and satisfaction (0.155) , team redevelopment (0.141) 〕, 16 second-level indicators, and 48 third-level indicators.

The IMOI model-based FDTEES developed by us assesses the effectiveness of family doctor teams in Beijing from a team perspective, which may be a reference for effectiveness evaluation and development of family doctor teams in Beijing.