Better performance of PIVKA-II for detecting hepatocellular carcinoma in patients with chronic liver disease with normal total bilirubin

BACKGROUND Serum protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) is a promising biomarker for hepatocellular carcinoma(HCC) surveillance.AIM To identify the contributing factors related to the abnormal elevation of PIVKA-Ⅱ level and assess their potential influence on the performance of PIVKA-Ⅱ in detecting HCC.METHODS This study retrospectively enrolled in 784 chronic liver disease(CLD) patients and 267 HCC patients in Mengchao Hepatobiliary Hospital of Fujian Medical University from April 2016 to December 2019. Logistic regression and the area under the receiver operating characteristic curve(AUC) were used to evaluate the influencing factors and diagnostic performance of PIVKA-Ⅱ for HCC, respectively.RESULTS Elevated PIVKA-Ⅱ levels were independently positively associated with alcohol-related liver disease, serum alkaline phosphatase(ALP), and total bilirubin(TBIL) for CLD patients and aspartate aminotransferase(AST) and tumor size for HCC patients(all P < 0.05). Serum PIVKA-Ⅱ were significantly lower in patients with viral etiology, ALP ≤ 1 × upper limit of normal(ULN), TBIL ≤ 1 × ULN, and AST ≤ 1 × ULN than in those with nonviral disease and abnormal ALP, TBIL, or AST(all P < 0.05), but the differences disappeared in patients with early-stage HCC. For patients with TBIL ≤ 1 × ULN, the AUC of PIVKA-Ⅱ was significantly higher compared to that in patients with TBIL > 1 × ULN(0.817 vs 0.669, P = 0.015), while the difference between ALP ≤ 1 × ULN and ALP > 1 × ULN was not statistically significant(0.783 vs 0.729, P = 0.398). These trends were then more prominently perceived in subgroups of patients with viral etiology and HBV alone.CONCLUSION Serum PIVKA-Ⅱ has better performance in detecting HCC at an early stage for CLD patients with normal serum TBIL.

Evaluation of Impact of Life-planning Skills Training among Senior High School Students in Shangcai County

Objective To evaluate the impact of sex and reproductive health education using lifeplanning skills training among senior high school students in a rural county. Methods The study was conducted in three senior high schools of Shangcai County with comparable socio-cultural, economic, and demographic characteristics, two as intervention sites and one as the control. A three-month life-planning skills training course was conducted among all grade one students in the intervention schools. The baseline survey was conducted prior to the intervention, once again three months after the intervention was initiated. Data were collected through questionnaires, FGDs and 1Dis to evaluate the effect of the intervention program. Results After the intervention, the median score of reproductive health knowledge was higher in the intervention group （55.66） than that in control group （38.68）. Students from the intervention group were also more comfortable with their developmental changes which were going through, In the end line survey, 92.70% of the students in the intervention group suggested that reproductive health education should be carried out among all middle school students in Shangcai County. Multivariate analysis also indicated that peers and family had a significant effect on students＇ sex-related knowledge, attitudes and behaviors. Conclusion Sex and reproductive health education via provision of life-planning skills training can significantly increase students＇ sex and reproductive health knowl- edge and was welcomed by students, teachers and parents.

Healthcare practice strategies for integrating personalized medicine:Management of COVID-19

Personalized medicine is the tailor-made clinical treatment to the individual characteristics of each patient.It may be considered an extension of traditional approaches to knowing and treating diseases.Personalized medicine has the potential to change the way of identification and management of health problems.Coronavirus disease 2019(COVID-19)is an infectious disease that primarily affects the patients’lungs.The first case of pneumonia of unknown cause was reported in Wuhan,China on December 31,2019.As thus,we are quickly approaching the era of personalized medicine.This review discusses the practices currently used in the management of COVID-19 and how they relate to person-alized medicine.

A Comprehensive Review of Long-Term Safety and Effectiveness of FACILLE Modified Sodium Hyaluronate Gel for Injection over 3 Years

FACILLE modified sodium hyaluronate gel was designed to be used for nasolabial fold (NLF) correction. However, no study has investigated the long-term safety and effectiveness of FACILLE. Thus, a retrospective study of 14 aesthetic clinics in China was conducted. This was the first large-scale, postmarketing study on FACILLE to evaluate the occurrence of adverse events (AEs) and provide essential information on the satisfaction of patients with FACILLE injections. This study recruited participants aged >18 years. FACILLE was injected into the NLFs on both sides of each participant’s face. The primary endpoint for safety was systemic or severe AEs at an injection site. Effectiveness was assessed on the basis of the participants’ subjective perceptions and satisfaction levels. Safety and effectiveness data were collected on the day of injection and at 2 weeks and 1, 3, 6, 9, 12, 18, 24, 30 and 36 months postinjection. In total, 1552 participants were enrolled (mean age, 29.1 years), and most of them (96.5%) were women. The mean injection volume was 1.39 ± 0.658 mL, and the average number of injections was 2.4 ± 1.68. AEs were reported by 205 participants (13.2%). All AEs occurred at local injection sites. No systemic or severe AEs were observed. Local pain was the most frequently reported AE regardless of the number of injections or the injection volume. Only eight AE cases were correlated with FACILLE administration, with two cases involving local allergic reactions. The participants self-reported that they perceived the procedure to have an effectiveness of ≥90% within 6 months postinjection although this percentage decreased substantially after 9 months. Their satisfaction level was >90% within 1 month postinjection but decreased gradually after 3 months. Our results indicate that the long-term safety of FACILLE injection is adequate. The high self-reported perceived effectiveness and satisfaction levels indicate the considerable potential of FACILLE injections for correcting NLFs.

Poor CD4 count is a predictor of untreated depression in human immunodeficiency virus-positive African-Americans

AIM: To determine if efforts to improve antiretroviral therapy(ART) adherence minimizes the negative impact of depression on human immunodeficiency virus(HIV) outcomes. METHODS: A cross-sectional study of a clinic-based cohort of 158 HIV seropositive(HIV+) African Americans screened for major depressive disorder(MDD) in 2012. CD4 T lymphocyte(CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count(< 350 cells/mm3). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders. RESULTS: Out of 147 individuals with available CD4+ T lymphocyte data, 31% had CD4+ count < 350 cells/mm^3 and 28% reported poor ART adherence. As expected the group with > 350 cells/mm^3 CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm3 CD4+ T lymphocyte count(P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.CONCLUSION: Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients.

Comparison of optical quality after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis

AIM： To compare the optical quality after implantation of implantable collamer lens（ICL） and wavefront-guided laser in situ keratomileusis（WG-LASIK）.METHODS： The study included 40 eyes of 22 patients with myopia who accepted ICL implantation and 40 eyes of 20 patients with myopia who received WG-LASIK. Before surgery and three months after surgery, the objective scattering index（OSI）, the values of modulation transfer function（MTF） cutoff frequency, Strehl ratio, and the Optical Quality Analysis System（OQAS） values（OVs） were accessed. The higher order aberrations（HOAs） data including coma, trefoil, spherical, 2^（nd） astigmatism and tetrafoil were also obtained. For patients with pupil size 〈6 mm, HOAs data were analyzed for 4 mm-pupil diameter. For patients with pupil size ≥6 mm, HOAs data were calculated for 6 mm-pupil diameter. Visual acuity, refraction, pupil size and intraocular pressures were also recorded.RESULTS： In both ICL and WG-LASIK group, significant improvements in visual acuities were found postoperatively, with a significant reduction in spherical equivalent（P〈 0.001）. After the ICL implantation, the OSI decreasedslightly from 2.34±1.92 to 2.24±1.18 with no statistical significance（P=0.62）. While in WG-LASIK group, the OSI significantly increased from 0.68±0.43 preoperatively to 0.91±0.53 postoperatively（Wilcoxon signed ranks test, P=0.000）. None of the mean MTF cutoff frequency, Strehl ratio, OVs showed statistically significant changes in both ICL and WG-LASIK groups. In the ICL group, there were no statistical differences in the total HOAs for either 4 mmpupil or 6 mm-pupil. In the WG-LASIK group, the HOA parameters increased significantly at 4 mm-pupil. The total ocular HOAs, coma, spherical and 2^（nd） astigmatism were 0.12±0.06, 0.06±0.03, 0.00±0.03, 0.02±0.01, respectively. After the operation, these values were increased into 0.16±0.07, 0.08±0.05,-0.04±0.04, 0.03±0.01 respectively（Wilcoxon signed ranks test, all P〈0.05）. At 6 mm-pupil, the induction of total HOAs was not statistically significant in the WG-LASIK group. CONCLUSION： ICL implantation has a less disturbance to optical quality than WG-LASIK. The OQAS is a valuable complementary measurement to the wavefront aberrometers in evaluating the optical quality.

Nexus of signaling and endocytosis in oncogenesis driven by non-small cell lung cancer-associated epidermal growth factor receptor mutants

Epidermal growth factor receptor(EGFR) controls a wide range of cellular processes, and aberrant EGFR signaling as a result of receptor overexpression and/or mutation occurs in many types of cancer. Tumor cells in non-small cell lung cancer(NSCLC) patients that harbor EGFR kinase domain mutations exhibit oncogene addiction to mutant EGFR, which confers high sensitivity to tyrosine kinase inhibitors(TKIs). As patients invariably develop resistance to TKIs, it is important to delineate the cell biological basis of mutant EGFR-induced cellular transformation since components of these pathways can serve as alternate therapeutic targets to preempt or overcome resistance. NSCLC-associated EGFR mutants are constitutively-active and induce ligandindependent transformation in nonmalignant cell lines. Emerging data suggest that a number of factors are critical for the mutant EGFR-dependent tumorigenicity, and bypassing the effects of TKIs on these pathways promotes drug resistance. For example, activation of downstream pathways such as Akt, Erk, STAT3 and Src is critical for mutant EGFR-mediated biological processes. It is now well-established that the potency and spatiotemporal features of cellular signaling by receptor tyrosine kinases such as EGFR, as well as the specific pathways activated, is determined by the nature of endocytic traffic pathways through which the active receptors traverse. Recent evidence indicates that NSCLCassociated mutant EGFRs exhibit altered endocytic trafficking and they exhibit reduced Cbl ubiquitin ligasemediated lysosomal downregulation. More recent work has shown that mutant EGFRs undergo ligand-independent traffic into the endocytic recycling compartment, a behavior that plays a key role in Src pathway activation and oncogenesis. These studies are beginning to delineate the close nexus between signaling and endocytic traffic of EGFR mutants as a key driver of oncogenicprocesses. Therefore, in this review, we will discuss the links between mutant EGFR signaling and endocytic properties, and introduce potential mechanisms by which altered endocytic properties of mutant EGFRs may alter signaling and vice versa as well as their implications for NSCLC therapy.

Adolescent Reproductive Health: Challenges and Change

The field of reproductive health has had long ronnaents in ways that other health fields have not experience negotiating challenging enviperhaps because other health fields usually deal with illness which everyone agrees is not a good thing. Or maybe because we have all been born, we all think we know something about reproduction. Whatever the reason, we have over the years seen bitter political and ideological debates over population and family planning, abortion, the treatment of HIV/AIDS, in vitro fertilization, new contraceptive technologies--and now adolescent reproductive health. We shouldn＇t be surprised. But just as we have had to prevail in those debates in the past, they are crucial today： the numbers of young people entering their reproductive years throughout the world, especially the developing world, make it essential that youth be reached not only with messages and services crafted in the last 40 years but also with new messages, new ideas and new services.

The Influence of Pyrazinamide Monoresistance on Treatment Outcomes in Tuberculosis Patients from Southern China

This study aimed to explore the influence of pyrazinamide (PZA) monoresistance on the treatment outcome of otherwise drug susceptible tuberculosis (TB). A cohort of 194 TB patients that were infected with strains susceptible to isoniazid (INH), rifampin (RIF) and ethambutol (EMB) were included in a retrospective study at the Guangzhou Chest Hospital. We reported 148 (76.3%) PZA- susceptible TB cases and 46 (23.7%) PZA-monoresistance TB cases identified by the BACTEC MGIT 960 system. All patients were treated with the standard 6 months WHO recommended regimen, which included 2 months of INH + RIF + EMB + PZA in the intensive-phase, and the subsequent 4 months of INH + RIF during continuation-phase. Bacterial burden in the lungs was estimated using sputum smear acid-fast bacillary count while the lung lesions and cavitations were examined by X-ray at the end of first 2 months of chemotherapy. After intensive-phase treatment, there were 164 (84.5%) cases of smear-negative conversion and 151 (77.9%) cases of total or partial lesion elimination. The rates of smear-negative conversion (78.3%) and lesion elimination (39.1%) of the PZA-monoresistant patients were similar with the PZA-sensitive group (P > 0.05). However, lung cavitation was more likely to be resolved in PZA-sensitive patients than in the PZA-patients (X2 = 9.623, P = 0.002). The smear-negative conversion rates were 95.9% for the PZA-sensitive patients and 87.0% for the PZA-monoresistant patients after 6 months of treatment (X2 = 3.461, P = 0.063). Together, our data suggest that PZA-monoresistance contributes to the delay of resolution of the lung cavitations in the Southern China population without affecting the sputum conversion and lesion elimination rates.

Expanding the Scope of Multivariate Regression Approaches in Cross-Omics Research

Recent technological advancements and developments have led to a dramatic increase in the amount of high-dimensional data and thus have increased the demand for proper and efficient multivariate regression methods.Numerous traditional multivariate approaches such as principal component analysis have been used broadly in various research areas,including investment analysis,image identification,and population genetic structure analysis.However,these common approaches have the limitations of ignoring the correlations between responses and a low variable selection efficiency.Therefore,in this article,we introduce the reduced rank regression method and its extensions,sparse reduced rank regression and subspace assisted regression with row sparsity,which hold potential to meet the above demands and thus improve the interpretability of regression models.We conducted a simulation study to evaluate their performance and compared them with several other variable selection methods.For different application scenarios,we also provide selection suggestions based on predictive ability and variable selection accuracy.Finally,to demonstrate the practical value of these methods in the field of microbiome research,we applied our chosen method to real population-level microbiome data,the results of which validated our method.Our method extensions provide valuable guidelines for future omics research,especially with respect to multivariate regression,and could pave the way for novel discoveries in microbiome and related research fields.

Longitudinal assessment of liver stiffness by transient elastography for chronic hepatitis C patients

BACKGROUND Liver fibrosis is a common pathway of liver injury and is a feature of most chronic liver diseases.Fibrosis progression varies markedly in patients with hepatitis C virus(HCV).Liver stiffness has been recommended as a parameter of fibrosis progression/regression in patients with HCV.AIM To investigate changes in liver stiffness measured by transient elastography(TE)in a large,racially diverse cohort of United States patients with chronic hepatitis C(CHC).METHODS We evaluated the differences in liver stiffness between patients treated with direct-acting antiviral(DAA)therapy and untreated patients.Patients had≥2 TE measurements and no prior DAA exposure.We used linear regression to measure the change in liver stiffness between first and last TE in response to treatment,controlling for age,sex,race,diabetes,smoking status,human immunodeficiency virus status,baseline alanine aminotransferase,and baseline liver stiffness.Separate regression models analyzed the change in liver stiffness as measured by kPa,stratified by cirrhosis status.RESULTS Of 813 patients,419(52%)initiated DAA treatment.Baseline liver stiffness was 12 kPa in 127(16%).Median time between first and last TE was 11.7 and 12.7 mo among treated and untreated patients,respectively.There was no significant change in liver stiffness observed over time in either the group initiating DAA treatment(0.016 kPa/month;CI:-0.051,0.084)or in the untreated group(0.001 kPa/mo;CI:-0.090,0.092),controlling for covariates.A higher baseline kPa score was independently associated with decreased liver stiffness.CONCLUSION DAA treatment was not associated with a differential change in liver stiffness over time in patients with CHC compared to untreated patients.

Prevalence of Human Immunodeficiency Virus (HIV), Risk Behavior, and Recent Substance Use in a Sample of Urban Drug Users: Findings by Race and Sex

The aim of the current study was to examine the prevalence of HIV, past six-month illicit drug use, and risk behaviors among a population of heavy drug users living in an urban setting. Although many studies investigate substance use, sex-risk behavior, and HIV by race and gender, no studies have examined these variables simultaneously. The current study seeks to fill this gap in the literature by exploring HIV prevalence among a predominantly heterosexual sample of recent substance users by injection drug use (IDU) status, race, and sex. Baseline data from the Baltimore site of the NEURO-HIV epidemiologic study was used in this study. This study examines neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and hepatitis C among both injection and non-injection drug users. Descriptive statistics and chi-square statistics were used in data analyses. Blood and urine samples were obtained to test for the presence of recent drug use, viral hepatitis, HIV, and other sexually transmitted diseases (STDs). Findings presented here have several important implications for HIV prevention and care among substance users. Intervention programs that incorporate substance use treatment in addition to HIV education, particularly with respect to substance use and sex risk behavior are imperative.

Using Geographic Information Systems (GIS) for Targeted National Recruitment of Community-Dwelling Caregivers Managing Dementia-Related Behavioral and Psychological Symptoms: A Recruitment Approach for a Randomized Clinical Trial

Over 16 million caregivers of people living with dementia require support in a range of issues, including self-care, disease education, and guidance for how to manage behavioral and psychological symptoms of dementia (BPSD). Non-pharmacological interventions are needed to address these areas, and online applications have been shown to be safe and effective. To ensure the efficacy of such interventions, racially, ethnically, geographically, and socioeconomically diverse participants must be recruited to increase the generalizability of study outcomes. This protocol paper describes a recruitment plan using Geographic Information Systems (GIS) to reach a representative sample of caregivers across the United States for a national Phase III clinical study. Using publicly available census data from the American Community Survey (ACS), combined with location data for local aging resources such as Area Agencies on Aging (AAA), recruitment will be derived from data analysis conducted in ESRI ArcGIS v10.7.1. Datasets including age, gender, income, and education will be assessed nationally at the county and census tract spatial scale in a nine-step process to develop recruitment priority areas containing high concentrations of eligible participants living in the community. Overall, the current protocol will demonstrate the value of GIS in tailoring targeted outreach strategies to recruit community-dwelling populations through local resource institutions. This novel approach may have far-reaching implications in future recruitment initiatives and help to secure racially/ethnically diverse samples.

Synthesis and Trypanocidal Evaluation of Some Novel 2-(Substituted Benzylidene)-5, 7-Dibromo-6-Hydroxy-1-Benzofuran-3(2<i>H</i>)-Ones

Substituted 2-benzylidene-1-benzofuran-3-ones are commonly known as aurones. This class of bioactive heterocycles belongs to flavonoid family. The article intends to put forth the rational design and synthesis of a new series of aurones using 3’,5’-dibromo-2’,4’-dihydroxychalcones and copper bromide in presence of DMF-water mixture (8:2, v/v) for the first time. Preliminary bioassay shows that most of compounds have good trypanocidal activity against Trypanosoma cruzi at 10 μg/mL. Few compounds are equally potent to the standard drugs Benznidazole and Nifurtimox. The structures of the newly synthesized products 2a-n were established by elemental analysis, FTIR, 1H NMR, 13C NMR and mass spectroscopic studies.

TALEN-Mediated FLAG-Tagging of Endogenous Histone Methyltransferase DOT1L

Histone modification including H3 lysine 79 methylation (H3K79me) plays a key role during gene transcription and DNA damage repair. DOT1L, the sole methyltransferase for three states of H3K79me, is implicated in leukemia, colorectal cancer, and dilated cardiomyopathy. However, understanding of DOT1L and H3K79me in these pathways and disease pathogenesis has been limited due to the difficulty of working with DOT1L protein. For instance, locus-specific or genome-wide binding sites of DOT1L revealed by chromatin immunoprecipitation (ChIP)-based methods are necessary for inferring its functions, but high-quality ChIP-grade antibodies are currently not available. Herein we have developed a knock-in approach to tag endogenous DOT1L with 3 × Flag at its C-terminal domain to follow functional analyses. The knock-in was facilitated by using TALENs to induce a targeted double-strand break at the endogenous DOTIL to stimulate local homologous recombination at that site. The single cell colonies with successful knock-in were isolated and verified by different methods. We also demonstrated that tagged DOT1L maintains its normal function in terms of methylation and that the engineered cells would be very useful for further studies.

The public-private partnerships in healthcare sector in China

This manuscript is a narrative review on experience in the healthcare public-private partnerships(PPP)field project in China.The PPP model allows healthcare officials to share the risk of building new facilities with the private sector.The objective of this study is to evaluate and to review the PPP of healthcare sector in China,and to investigate the critical success factors and best practice of PPP.We adapted the PPP evaluation framework of the World Bank Independent Evaluation Group as our conceptual framework to summarize the literatures.The current study systematically reviewed the evolution and current status of public and private hospitals development in China,and to investigate factors related to the successful and less successful deployment and performance of PPP in the healthcare sector of China,and to develop best practice models of PPP among hospitals of China.We found that the PPP organizations providing finance and political risk coverage,thus enabling specific PPP transactions to reach financial closure-potentially setting demonstration effects.Such PPPs may then contribute to improving access to infrastructure and social services,which drives economic growth and other optimal outcomes.

用非离子去垢剂抽提获得的小游仆虫皮层细胞骨架的构形

由扫描电镜术显示 ,应用非离子去垢剂抽提获得的小游仆虫 (Euplotesgracilis)皮层细胞骨架是由非纤毛区皮层骨架、纤毛器骨架及其附属纤维等构成的三维结构网架。各类细胞骨架以纤维物质为基本成分组成纤维网、纤维层、纤维束和纤维薄片等不同形态单元。其中 :非纤毛区皮层骨架以表面纤维网和表膜下纤维层为形态单元位于细胞的外周层 ;纤毛器骨架中的口围带骨架、口侧膜骨架、额腹横棘毛骨架按各自的分布图式在皮层内定位 ,成为主要的皮层骨架结构。尽管这些纤毛器骨架显示不同的形态 ,但却具有相同的建构特征 ,即都是由纤毛器的毛基体、纤毛器托架和骨架附属纤维相互联系镶嵌在一起形成的相对独立的结构单元。分析推测 ,游仆虫皮层表面纤维网使细胞表面形成区域化结构 ,它也可能与细胞表面各部分的联系及其细胞与环境的相互作用有关 ;纤毛器骨架中各个纤毛器的毛基体复合结构可能对纤毛器托架和骨架附属纤维等起到微管组织中心的作用。

叶绿酸对肝癌高发区黄曲霉毒素暴露人群的干预研究

[目的]评估叶绿酸能否降低肝癌高危人群尿中黄曲霉毒素(AFT)鄄N7鄄鸟嘌呤的水平。[方法]采用随机双盲、以安慰剂为对照的预防干预试验。将180名健康成人随机分成叶绿酸干预组(服用100mg叶绿酸)和安慰剂对照组。采用顺序免疫亲和色谱法和液相色谱法结合电子喷射质谱法测定尿中AFT鄄N7鄄鸟嘌呤的变化。[结果]在169份尿样中,105份检出AFT鄄N7鄄鸟嘌呤。叶绿酸组尿中AFT鄄N7鄄鸟嘌呤比安慰剂组下降了55%(P=0.036)。未见副作用。[结论]应用叶绿酸或富含叶绿素的食物进行预防干预是可能阻断肝癌的有效手段。

Overview of particulate air pollution and human health in China: Evidence, challenges, and opportunities

Ambient particulate matter(PM)pollution in China continues to be a major public health challenge.With the release of the new WHO air quality guidelines in 2021,there is an urgent need for China to contemplate a revision of air quality standards(AQS).In the recent decade,there has been an increase in epidemiological studies on PM in China.A comprehensive evaluation of such epidemiological evidence among the Chinese population is central for revision of the AQS in China and in other developing countries with similar air pollution problems.We thus conducted a systematic review on the epidemiological literature of PM published in the recent decade.

英国按质量支付的经验及中国情境下的思考

医疗费用快速增长和医疗质量欠佳是当前中国面临的两大问题,从国际经验来看按质量支付是解决这两大问题的有效尝试。本文以英国的质量与结果框架(QOF)为典型案例,系统说明了英国按质量支付的内容、实施效果及未来走向,旨在为中国支付方式改革提供经验借鉴。本文利用政策方案分析框架,从政治、技术、经济、行政4个方面分析了中国情境下推行按质量支付的可行性,认为按质量支付在中国应用的前景良好但目前仍缺乏大范围推广的条件,未来可以先在门诊慢性病和中医药支付中试点,将按质量支付有机融入多元复合式医保支付体系并不断探索其应用领域。