In January 2022, Longhua District, Shenzhen piloted a digitally enabled generalist and specialist collaborative care model to deliver consistent, continues services for patients with chronic conditions managed in community health centers. This system-level initiative integrated hospital-based specialists and community-based general practitioners through a vertically aligned care model supported by a shared digital platform.

To evaluate the effect of this digitally enabled generalist-specialist collaborative care model on hypertension management capacity at community health centers.

We employed a difference-in-difference approach to examine changes in center level outcomes before and after the model was implemented during 2021-2024. The treatment group included 84 health centers in Longhua District, and the comparison group included 448 health centers in the rest of districts that were not influenced by the policy. Health centers in treatment group used the collaborative care model to delivery follow-up services, whereas health centers in comparison groups continued to provide routine services in accordance to the National Basic Public Health Services Program Standards (Third Edition) . Multivariate linear regression with district and time fixed effects was constructed, controlling for health center characteristics and adjusting for inverse probability of treatment weights, with standard errors clustered at the center level. Robustness checks were conducted to evaluate the reliability and stability of the model.

After the implementation of the digitally enabled collaborative care model, compared to centers in comparison groups, on average, quarterly standardized hypertension management rate and hypertension control rate in the treatment group increased by 4.3-percentage-point (DID=0.043, SE=0.011, P<0.001) and 11.5-percentage-point increase (DID=0.115, SE=0.012, P<0.001) per center, respectively. On average, the quarterly number of upward referrals per center decreased by 17.1% (P=0.038) , and the quarterly number of total patient visits per centers increased by 22.1% in treatment group (P=0.003) , as compared to comparison groups.

Our study highlights the significance of the digitally enabled specialist and generalist collaborative care model in enhancing health center capacity in hypertension management, reducing upward referrals, and optimizing resource utilization. Our study underscores the importance of incorporating this initiative into national health strategies, such as the National Basic Public Health Services Program, to strengthen chronic care management services delivery in more areas of China. Future policies and research should focus on scaling up this approach to a broader range of medical conditions and prioritizing investments in health centers by ensuring stable funding streams and optimizing the implementation strategies for digital integration pathway.

The advancement of high-quality national basic public health services continues to faces critical challenges, including insufficient quality resources in primary care and limited diagnostic and treatment capabilities. Since January 2022, Longhua District, Shenzhen initiated a pilot of the digitally enabled generalist-specialist collaborative care, aiming to enhance the capacity of primary healthcare service in managing hypertension and diabetes. This initiative leveraged the national basic public health services platform and the integration of medicine and prevention. Through policy guidance, system development, and digital support, the model sought to facilitate the efficient distribution and utilization of quality medical resources. This study presented the practical experiences of implementing the model from three key dimensions: policy mechanisms, practical measures, and early achievement. The preliminary practical achievements included: (1) Patient monitoring and enrollment: from 2022 to 2024, the proportion of hypertensive patients enrolled due to two consecutive instances of poor blood pressure control within six months was 35.3%, 37.5%, and 36.2%, respectively; the proportion of diabetic patients enrolled due to two consecutive instances of poor blood glucose control within six months was 55.5%, 64.0%, and 47.5%, respectively. (2) Specialist consultation: the timely consultation rates for hypertension and diabetes increased by 46.3% and 53.9%, respectively, in 2024, as compared to 2022, following the inclusion of the timely consultation rate in the performance evaluation of the medical consortium at the end of 2023. (3) Implementation by general practitioners: from 2022 to 2024, the timely implementation rate for hypertension increased from 73.7% to 84.3%, and for diabetes, from 73.9% to 80.8%. (4) Outcomes of patients managed by general practitioners and specialists: the average control rates during 2022 and 2024 for enrolled patients with hypertension and diabetes were 57.1% and 50.9%, respectively. The pilot experiences indicated that the digitally enabled generalist-specialist collaborative care effectively improved the management capacity of hypertensive and diabetic patients in primary care settings, contributing to better patient outcomes. At this critical juncture in advancing the high-quality development of national basic public health services, it was essential to establish implementation standards, strengthen supporting policy mechanisms and implementation strategies, and optimize the assessment and evaluation framework for basic public health services. These steps were vital to ensuring the successful nationwide adoption of this innovative policy model.

Health informatisation is an effective means to enhance the service capacity of primary healthcare institutions. Since the 12th Five-Year Plan, Sichuan Province has attached great importance to the construction of primary health informatisation, with a view to realising the enhancement of the management level and service capacity of primary healthcare institutions empowered by health information. However, there is a lack of research on the current status of health informatisation construction and application in the province.

Summarise the current situation and effectiveness of information technology construction in primary healthcare institutions in Sichuan Province.

From May to June 2023, a questionnaire survey was conducted on 143 district and county health administrative departments and 1 028 primary healthcare organisations in 21 cities and states in Sichuan Province using stratified random sampling method. The questionnaires were developed in terms of information personnel, information infrastructure, information systems, and IT applications. The questionnaires were deployed in the unified primary healthcare platform at the provincial level and were filled in by personnel familiar with information technology construction in each primary healthcare institution.

In terms of personnel, 40.95 per cent (421/1 028) of the institutions had information staff, with an average of (0.48±1.12) part-time staff and (0.25±1.08) full-time staff per institution. Information standardisation has been completed in primary healthcare institutions, forming a pattern of coordinated construction at the provincial level. In terms of system construction, 98.83 per cent (1 016/1 028), 99.61 per cent (1 024/1 028) and 99.32 percent (1 021/1 028) were equipped with the HIS, the basic public health service system, and the contracted management system for family doctors, respectively, an average of (2.28±2.63) clinical service systems, (2.56±1.97) medical management systems, and (10.00±20.81) out-of-hospital/supervisory bar systems were used. In terms of technology application, the rate of electronic health records reached 94.93% (2 021/2 129), the total use of electronic medical records reached 77.43% (796/1 028), and 32.60% (1 091/3 347) of the institutions' TCM centres were connected to the Sichuan Provincial TCM Center Health Information Platform, which realized health record access, consultation contracting, consultation follow-up, and configuration of terminals for basic public health services accounted for 83.46% (858/1 028), 56.91% (585/1 028), 68.77% (707/1 028), and 81.91% (842/1 028), respectively, and 74.12% (762/1 028) of the institutions at the upper and lower levels of the healthcare consortium carried out business synergies.

Since the 'Twelfth Five-Year Plan', the overall construction of information technology in primary healthcare institutions in Sichuan Province has been better, showing the development trend of comprehensive consolidation of infrastructure, diversified development of basic medical service functions, integrated integration of basic public health service functions, gradual adaptation of information technology to the development of integrated healthcare service system, and continued expansion of the application of new technologies. Eco-application scenarios of primary healthcare informatisation.

With the comprehensive launch of the information construction of China's close-knit county-level medical consortium, localities are making full use of Internet information technology to explore mechanisms suitable for the development of county-level medical consortium, and how to rely on information technology construction to enhance the capacity of primary health care services has become an important issue.

Explore the mechanism of information construction to empower the high-quality development of compact medical consortium.

Purposive sampling method was used to conduct semi-structured interviews in December 2023 with 28 medical staff from the medical community in County G. The interview topics centered on the characteristics and highlights of the medical community in the construction of information technology, its effectiveness, and the application of information technology in the internal management of the medical community, etc. At the same time, policy documents and news reports on the construction of the county-level medical community were selected to serve as the secondary data. The interview data and secondary data were coded and analysed through open coding, axial coding and selective coding, following programmed rooting theory approach.

Through open coding, 134 concepts and 48 basic categories were extracted; 6 main categories were obtained through axial coding. Theoretical framework was formed through selective coding, which mainly consists of 4 mechanisms, they were the mechanism of top-down linkage, the mechanism of integration of medical treatment and prevention, the mechanism of data sharing, the mechanism of fund management.

County G medical consortium improves the top-level design and strengthens the unified management and responsibility implementation of the medical consortium; and empowers the division of labor, service integration, interconnection and benefit-sharing mechanism among units of the compact county-level medical consortium through informatization, so as to promote the high-quality development of the compact county-level medical consortium.

Health co-prosperity is the conceptual interpretation and application extension of the logic of common prosperity in the field of health. Building a digital collaborative health governance model between Chinese and western medicine based on the advantages of digital reform is the "Zhejiang Model" of health co-prosperity and helps to achieve the goal of high-quality full life cycle medical and health services. This article is based on the collection of relevant policies on the digital collaboration between Chinese and western medicine during the construction of the Common Prosperity Demonstration Zone in China and Zhejiang Province. It elaborates on the definition and connotation of health co-prosperity, and selects the digital Chinese and western coordinated health governance model of provincial, grassroots platforms, and medical institutions in Zhejiang Province as a specific case to explain the theme and path of the system design logic, grassroots platform logic, and institutional service logic of health co-prosperity, to provide reference and suggestions for the innovative construction and optimization of the collaborative health governance model between Chinese and western medicine.

Since its implementation, residents' electronic health records have achieved phased results. The target of the filing rate in Shenzhen, Guangdong Province has been achieved, and the utilization rate has become the core index of theoptimization management of this work.

To understand the use of electronic health records of residents in Bao'an District, Shenzhen, and to analyze the influencing factors. It provides a basis for improving the utilization rate of health records and optimizing the allocation of community health resources.

As of 2022-12-31, Shenzhen Community Health Service information system had a total of 4 077 665 electronic health records of Bao 'an District residents. 403 700 electronic health records were selected by systematic sampling method, and 401 853 meeting the requirements of the study were selected for analysis.

The utilization rates of health records in 1 year, 2 years and 3 years were 59.30% (238 131/401 853), 74.90% (301 032/401 853) and 80.10% (321 853/401 853). The results of multivariate Logistic regression analysis showed that age, nationality, resident type, marital status, education level, profession, payment methods for medical expenses, duration of filing, as well as whether the health records were signed by a family doctor, the elderly, the hypertension and the diabetes were residents' electronic health records influencing factors of 1, 2 and 3 years use (P<0.05). Among them, compared with residents aged 21-45, the use rate of electronic health records in 1, 2 and 3 years was higher for residents aged 0-1, 2-3 and 4-6 years (OR>1.00, P<0.05) ; the usage rate of electronic health records for residents aged 46-60 and ≥61 years was lower in 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with non-resident residents of Shenzhen, the use rate of electronic health records of residents with permanent residence in Shenzhen was higher at 1, 2 and 3 years (OR>1.00, P<0.05) ; compared with the residents participating in the basic medical insurance for urban employees, the use rate of electronic health records of residents with basic medical insurance, full self-payment and other medical expenses payment methods for urban residents was lower in 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with residents with a filing period of<1 year, the use rate of electronic health records of residents with a filing period of≥1 year was lower at 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with the residents without the corresponding project identification, the 1-year utilization rate of electronic health records with family doctor contract identification, elderly project identification, hypertension project identification, and diabetes project identification was higher[OR (95%CI) was 3.77 (3.70-3.84), 2.73 (2.53-2.94), 4.40 (4.11-4.72), 3.10 (2.78-3.47), P<0.05], respectively, and the 2-years and 3-years usage rates were also higher (OR>1.00, P<0.05) .

The usage rate of electronic health records among residents in Bao'an District has risen compared to previous levels, but there is still potential for further enhancement. Priority should be given to non-elderly people, middle-aged and elderly people identified by the hypertension/diabetes program, and residents who have not signed a family doctor, basic medical insurance for urban residents, payment methods for self-payment and other medical expenses, and non-household registration residents.

In children, autism spectrum disorder (ASD) is primarily characterized by social (communication) impairments and repetitive, stereotyped behaviors and restricted interests, affecting children's social interaction, communication abilities, and behavioral patterns. In recent years, with technological advancements, digital therapeutics has played a significant role in managing ASD. For instance, multimodal data integration and machine learning algorithms have been used for the early identification of ASD, while virtual reality, augmented reality, and gamified learning platforms have been widely applied to enhance the social skills and cognitive functions of children with ASD. Although digital therapy has shown great potential and benefits in the field of autism, it also faces challenges, including individual differences in treatment response, uncertainty of long-term effectiveness, and data privacy protection. Overall, digital therapeutics has opened up a new path for the management of autism, and also points out important directions for future research and applications.

With the acceleration of the aging process of the population and the change of the disease spectrum of residents, the prevalence of chronic diseases such as diabetes is increasing year by year. It is urgent to establish a wide coverage and efficient medical prevention integration mode. Most of the existing studies have focused on the demand for health management services and the influencing factors of service adoption, and few have identified and analyzed the demand for chronic disease healthcare and prevention integration services under digital technology.

To explore the demand of residents for medical and preventive integration services for diabetes in the context of digital health, and the impact of different service contents on the acceptance and satisfaction of service objects, so as to provide a theoretical basis for the public to improve the whole process and all-round medical and preventive integration services.

Combined with relevant research and practical work, 20 survey items on demand for diabetes medical and prevention integration services were established. From January to June 2023, convenient sampling method was used to survey diabetes patients and risk groups in Fujian Province, Guangdong Province and Yunnan Province, and 410 respondents' data were obtained. According to five demographic characteristics of gender, age, education level, residence type and medical insurance type, attribute classification analysis was carried out according to Kano model analysis method, to investigate the relationship between service demand of different attributes and residents' satisfaction, and then put forward the supply strategy of diabetes medical and prevention integration services.

Residents with different demographic characteristics show common and individual differences in the demand for medical and preventive integration services for diabetes. Among them, the demand for services among people of different ages and educational levels is quite different. The demand for medical prevention integration services of diabetes prevention and treatment groups focuses on screening, prevention and treatment, but the relevant convenient services provided by the Internet and social media have nothing to do with user satisfaction.

The level of personalization of diabetes primary health care and prevention services should be improved to fully satisfy the needs of the service population for essential attributes such as "initial screening for diabetes and complications", improve the services for desired attributes such as "establishment of a full-cycle personal electronic health record", and enhance the services for charismatic attributes such as "risk prediction" and "remote health monitoring". It will also improve services with desired attributes such as the establishment of a full-cycle personal electronic health record, and enhance services with attractive attributes such as "risk prediction" and "remote health monitoring".

Although medicine is developing rapidly, many chronic diseases are still extremely challenging to manage and control at the moment. In China, the prevalence rates of hypertension are still on the rise, making early identification, therapy, and prevention of the condition crucial. Digital therapy makes use of the Internet to assist patients with hypertension in strengthening their understanding of hypertension, encouraging the proper administration of hypertension medication, and improving their ability to manage their own health. This paper aims to provide an overview of the current state of digital therapy application in the medical field, investigate the viability and suitability of these therapies for the treatment of hypertension, and anticipate the advancement of digital therapy-based hypertension management and treatment in the future. Future developments in digital therapy involve bringing together the knowledge of Chinese medicine health management, optimizing the benefits of digitizing both Chinese and western medicine for the diagnosis and treatment of hypertension, forming a professional team for digital therapy, safeguarding patient privacy and data security, and offering patients more convenient, effective, and secure preventive and treatment options.

High prevalence and low control rate of hypertension have brought a significant disease burden globally. In order to improve the level of hypertension prevention and treatment, remote healthcare and digital medicine have been rapidly developed and widely used worldwide. Currently, there are no relevant regulations in China for these technologies. In 2023, the Italian Society of Arterial Hypertension issued a position statement to guide the development, validation, and clinical use of remote medicine and digital healthcare. This article will interpret this position paper, focusing on the forms of application of telemedicine and digital healthcare in managing hypertension and its related cardiovascular diseases, key research evidence, existing advantages, as well as current opportunities and challenges. The aim is to guide general practitioners in China on how to utilize these technologies in managing hypertension and related cardiovascular conditions.

The impact of the COVID-19 on the whole society exposed the inadequacy of the modernization of the urban public health system and governance capacity, which has brought new challenges to the development of health care in China.Promoting digital medicine and building a modern urban medical system is an important starting point for implementing the healthy China strategy and promoting the development of China's modern medical cause, an important embodiment of the country's comprehensive strength, an important symbol of economic and social development and progress, an important way to improve the people's healthy life quality, it is of great significance to realize resource integration, optimize medical treatment process, reduce operating costs, improve service quality, improve work efficiency and management level. Starting from the analysis of the current situation of informationization construction in second and third level medical institutions in a certain municipality directly under the central government in China, this article focuses on how to adapt to the needs of the times, build intelligent digital hospitals, seek scientific solutions, plan future development positioning, provide a basis for policy and normative formulation in the field of digital healthcare, and better serve health administrative departments and public hospital managers, providing new ideas for medical reform for government decision-making departments.

Telerehabilitation based on digital medical care can efficiently improve the health status of patients after radiofrequency ablation of atrial fibrillation. However, the current participation rate in telerehabilitation is low.

To analyse the reasons for refusal of exercise rehabilitation in patients after radiofrequency ablation of atrial fibrillation in the context digital medical care based on the theory of leisure constraints.

Patients after radiofrequency ablation of atrial fibrillation in the inpatient department or outpatient clinic of Department of Cardiology, at the First Affiliated Hospital of Nanjing Medical University from July to September 2022 were selected as the study subjects by using the purposive sampling method. The phenomenological approach was adopted to collect data from patients who refused exercise telerehabilitation after radiofrequency ablation through semi-structured interviews, and Colaizzi analysis was used to summarize the reasons.

A total of 14 patients were finally included in this study. Three themes including self-limiting factors, interpersonal limiting factors, and structural limiting factors, and twelve sub-themes were extracted, namely, low level of digital literacy, negative illness perception, psychological distress caused by disease, digital medical trust crisis, deep-rooted personal exercise habits, alienation sense from rehabilitation team, insufficient social network establishment, economic burden related to equipment acquisition, harsh climate, low rehabilitation service capacity in primary care, constraints of available time by role pressure, and poor applicability of wearable devices.

The reasons for refusal to exercise telerehabilitation include lack of literacy and trust in digital medical care, high level of illness perception and psychological distress, poor exercise habits, rehabilitation team and peer alienation, economic burden, harsh climate, lack of capacity and personal time for rehabilitation service capacity in primary care, and inadequate applicability of existing wearable devices.

Insomnia is the most common sleep disorder, which not only causes individual health damage, but also brings heavy social and economic burden. The traditional insomnia treatment model has the disadvantages of complicated process and high cost. With the development of information technology, the more convenient and low-cost digital therapy for insomnia (DTI) has been increasingly utilized. However, there is still a lack of standardized guidelines for DTI globally. To address this issue, the China Sleep Research Society collaborated with domestic experts in sleep medicine and medical engineering to develop the Expert Consensus on Digital Therapies for Insomnia in China, elaborates on the definition, indications, core principles, research and development, promotion and application, education and training, data protection, ethical supervision, aiming to establish a unified and comprehensive framework for DTI.

Osteoarthritis has a high rate of disability and deformity, and can be combined with several physical and mental diseases. However, the early symptoms of the disease are not obvious. At present, there are problems in the management of osteoarthritis in the community such as uncoordinated management, inadequate methods and imperfect systems.

To construct and evaluate an informatics-based multidisciplinary management model for osteoarthritis patients in community, to promote the management of community osteoarthritis patients and improve the prognosis of the patients.

First a multidisciplinary management model of osteoarthritis patients in the community was constructed, including hierarchical management process of patients based on risk factor stratification, the multidisciplinary management team and its division of diagnosis and treatment, then an informatics based multidisciplinary management process was constructed, and information software development was completed. From July 2019 to July 2020, 80 patients with knee osteoarthritis who attended the general outpatient clinics of Dinghai and Daqiao Community Health Service Centers in Shanghai, and the orthopedics outpatient clinics of Yangpu District Central Hospital were randomly assigned into multidisciplinary management groups and general management group, with 40 patients in each group. The patients in general group were given conventional treatment, while the patients in multidisciplinary group were adopted information-based multidisciplinary management. Visual analogue scale (VAS) scores, Western Ontario McMaster University (WOMAC) osteoarthritis index score, the simplified scale of Arthritis Quality Of Life Measurement Scale (AIMS2) scores, Health Literacy Management Scale (HeLMS) scores, and body mass index (BMI) were assessed before and after 12 weeks of management, respectively.

Before treatment, there were no significant differences in VAS score, WOMAC osteoarthritis index score, AIMS2 score, Helms score, and BMI between patients with knee osteoarthritis in the multidisciplinary and general groups (P>0.05) . After 12 weeks of treatment, the VAS and WOMAC score of both the multidisciplinary and general groups went down, and the health literacy AIMS2 scores and Helms total score were higher after treatment than those before. The difference was statistically significant (P<0.05) . After 12 weeks of treatment, the AIMS2 total score and Helms total score of patients in the multidisciplinary group were higher than those in the general group, and the VAS score, WOMAC osteoarthritis index, and BMI were lower than those in the general group, with significant differences (P<0.05) .

The implementation of an informatics based community multidisciplinary management model for patients with osteoarthritis of the knee can effectively reduce the patients' joint pain and control their weight, improve their ability of daily living and health literacy, improve the quality of life of patients, and delay the progress of the disease.

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 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.

The implementation of bi-directional referrals may be affected directly by physicians since they play a crucial role in the process, but their performance in which will be facilitated by an orderly, efficient and interconnected referral system. So exploring the impact mechanism of informatization on physicians' performance in bi-directional referrals will greatly promote the implementation of such referrals and the development of hierarchical diagnosis and treatment.

To develop a qualitative model explaining the influence of informatization on physicians' intentions and behaviors regarding patient referrals, laying a foundation for relevant empirical research.

In April to October 2021, we performed a systematical review of studies about the influence of informatization on patient referrals collected from databases of CNKI, Wanfang Data, PubMed and Web of Science, then based on this and the framework of the Theory of Planned Behavior (TPB) , we developed a theoretical model explaining the impact of informatization on physicians' intentions and behaviors concerning patient referrals with self-defined latent variables and self-selected observed variables incorporated. After that, we used the theoretical model and the technology acceptance model to analyze patient referrals, then developed a corresponding business model.

The theoretical model contains six latent variables including behavior, intention, attitudes, subjective norm, perceived behavior control and informationization control-related factors, and observed variables for measuring each of the latent variables. The relationships between latent variables could be divided into correlation/covariance relationship and causality relationship. The business model could clearly reflect the influence of different levels of informatization on physicians' intention and behavior related to patient referrals. The business model indicates that the implementation of bi-directional referrals could be promoted with reduced difficulty only when information support sustains referral services delivered by hospitals in a collaborative way with patient information linked and shared, information system is further improved, and referral standards and information platforms are deeply integrated.

The development of this qualitative model may be a reference for constructing a quantitative model, and for the development of a bi-directional referral assessment system and the formulation of relevant policy documents in China, and may expand the applicable scope of the TPB.

The creation of health records for Chinese residents is a key task for deepening the reform of the pharmaceutical and healthcare system, and an important action for promoting the equity of essential public health services. However, domestic studies on resident health records are mainly using the data from a city or community, and those using the national data from a demand-side perspective are rather scarce.

To understand the creation and utilization of health records in Chinese residents.

From November to December 2019, multistage sampling was used to select three provinces/municipality (Zhejiang, Shanxi and Chongqing) from eastern, central and western China (one was extracted from each geographical region) , then from each of them, one urban district and one county were extracted. Randomly selected 2 community health centers/stations, township health centers/village clinics in the corresponding districts (counties) . Finally, 20 community health service centers/township health centers were selected, the visitors of these institutions were invited to attend a questionnaire survey for understanding their information about the creation of health records, and the access to the health records, as well as satisfaction with the services. For ease of analysis, the visitors were classified into six categories (0-6-year-olds, pregnant women, over 65-year-olds, hypertensioners, diabetics, and general population) in accordance with the population groups defined in the Essential Public Health Service Programs.

Altogether, 10 067 residents were included for final analysis. Among them, 9 119 (90.58%) self-reported that they had received health records creation services. The rates of creation of health records in 0-6-year-olds, pregnant women, over 65-year-olds without hypertension/diabetes, over 65-year-olds with hypertension, under 65-year-olds with hypertension, over 65-year-olds with diabetes, and under 65-year-olds with diabetes, as well as general population were 94.09% (2 787/2 962) , 95.60% (956/1 000) , 87.87% (616/701) , 88.87% (1 414/1 591) , 92.91% (747/804) , 89.41% (895/1 001) , 92.72% (471/508) , and 82.20% (1 233/1 500) , respectively. Among those with health records created, 67.02% (5 990 / 8 938) could access to their health records at any time, and the health records accessed by most of them were printed〔75.76% (4 538/5 990) 〕. However, 12.40% (1 108/8 938) of residents reported that they had no access to their health records, and other 20.59% (1 840/8 938) indicated that they had never tried to gain access to their health records. The rate of satisfaction with health records services in residents was 83.31% (4 352/5 224) . The rate of health records creation and rate of accessing the health records differed significantly by province, district or country, household monthly income per person, education level, and category of population (P<0.05) . The rates of satisfaction with the creation of and access to health records differed significantly by province, type of visited health institution, district or country, household monthly income per person, education level, and category of population (P<0.05) .

Generally, the rate of creation of health records in Chinese residents has significantly increased. The rate of utilization of the records has also enhanced, but needs further improvement. Moreover, residentssatisfaction with health records services may be at a moderate level.