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Objective:To learn the key driving factors in the management of scientific and technological achievements transformation in public hospitals, so as to provide basis for improving the effectiveness of achievements transformation.Methods:From March to July 2021, 1 226 medical staff from 7 municipal hospitals in Hangzhou were investigated by stratified random sampling. The questionnaire included the main demographic information, the perceived importance and actual performance of the management mechanism(6 dimensions, 18 items)which was scored by Likert 5. Descriptive analysis was carried out and paired samples were compared by t-test, and the difference was significant when P<0.05. Importance matrix analysis was carried out on all items to identify the key driving factors for the transformation of achievements in public hospitals. Results:1 157 valid questionnaires were finally included. The difference between the scores of perceived importance and actual performance of the various management mechanisms was significance( P<0.001). The gap was presented as follows: evaluation mechanism(1.29), investment mechanism(0.88), organization and leadership mechanism(0.87), guarantee mechanism of services(0.44), benefit and distribution mechanism(0.15), incentive mechanism(-0.11). Matrix analysis results showed that, " special funds support" , " grasp market demand and accurately connect" , " formulate corresponding supporting systems" , " professional transformation team with multidisciplinary background" , " classified and multi-level achievement transformation evaluation index system" , " full life cycle management" , " incorporate into central work and key tasks" and " scientific and technological achievement transformation reporting system and application monitoring system" were the key driving factors for the transformation of scientific and technological achievements in public hospitals. Conclusions:The perceived importance of medical staff to the transformation of scientific and technological achievements in public hospitals is acceptable, while the actual performance is relatively weak. The management effectiveness should be improved and give priority to consolidate the management foundation, build index evaluation system, provide the life cycle management service and improve scientific interaction as well as consultation service mechanism.
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Objective@#Based on the KAP and Prospect theory, to explore, construct and verify the theoretical model and formation mechanism of driving factors of primary care doctors′ willingness to carry out the primary diagnosis.@*Methods@#Using the random cluster sampling method, from April to May 2019, a questionnaire survey was conducted among doctors at 20 primary medical and health service institutions in Hangzhou. The survey covered the primary care doctors′ cognition level of primary diagnosis, their self-evaluation of primary medical care capabilities, evaluation of policies and systems, expectation of primary medical care, and their job satisfaction. Descriptive statistic, multiple linear regression and structural equation model were used to analyze and explore the driving factors and formation mechanism of their willingness to carry out the primary diagnosis.@*Results@#Primary care doctors′ willingness rate for primary diagnosis was 76.4%(308/403). Positive expectation(beta=0.309), cognition level(beta=0.216), evaluation of policies and systems(beta=0.184), and self-evaluation of primary diagnosis capability(beta=0.170), all of which directly affect the said willingness. The total effect of the five types of driving factors on the willingness of the primary diagnosis was as follows: cognitive level of the primary diagnosis(0.536), evaluation of the policy system(0.494), self-evaluation of the primary diagnosis capability(0.436), positive expectations of the primary diagnosis work(0.186), job satisfaction(0.146).@*Conclusions@#The cognition of the primary diagnosis, the capability of the primary diagnosis, the policy system and the positive expectation are the important premises, key driving forces, and a strong guarantee and motivation to drive primary care doctors to carry out the primary diagnosis. It is suggested that the government and medical institutions should further improve the cognition level of primary care doctors, focusing on systematically improving the service capability of primary care doctors′ primary consultation, coordinating to improve policy guidance measures such as financial input, medical insurance reimbursement and referral system, establishing and improving incentive measures such as career development, performance appraisal, salary and welfare of primary care doctors.
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OBJECTIVE：To provide reference for deepening the reform of medical insurance payment mode in China. METHODS：By analyzing the specific reform process and driving factors of American Medicare ，and considering the background of current payment reform in China ，then some suggestions were put forward to promote the reform of medical insurance payment mode in China. RESULTS & CONCLUSIONS ：The payment mode of Medicare in the United States had undergone three stages ， which were post-payment system ，pre-payment system and value-based payment system. The payment modes included payment by service items ，payment by disease diagnosis related groups （DRGs）and payment by service value. The change was the result of the comprehensive effect of the three systems of technology ，politics and social culture in the United States. The demand for reasonable treatment and control fees drove the change from post-payment system to pre-payment system ，while the crisis of service quality ， the rise of service cost and the contradiction between doctors and patients drove the change to value-based payment. Payment mode reform had a positive impact on Medicare in the United States ，reducing medical expenditure and improving the quality of service. It is suggested that China should draw lessons from the experience of the United States in reforming the prepayment system nationwide on the basis of the current DRGs pilot projects. Meanwhile ，in order to avoid the medical quality crisis in the later period of the United States ，it is necessary to introduce the concept of value-based payment ，establish incentive and restraint mechanisms and strengthen the construction of the regulatory supporting system for the whole process.