基于政策工具视角的中医院发展政策文本分析

目的：从政策工具视角对我国中医院发展政策文本进行分析，揭示现有政策工具存在的问题。方法：基于政策工具和中医院发展评价维度构建二维分析框架，采用内容分析方法对28份中医院发展政策文本进行分析。结果：供给型政策、环境型政策、需求型政策分别占总数量的40.79%、36.84%、22.37%。中医院发展评价维度分为资源配置、能力建设、职能落实、外部评价4部分。应用于这4个评价维度的政策工具的文本比例分别为35.53%、21.05%、39.47%、3.95%。结论：政策工具的选择和使用存在一定失衡，建议重视并丰富需求型政策工具，优化政策工具内部结构，提高群众对中医院的认知，完善中医院发展政策体系，提升中医院政策工具科学化水平。     

浙江省德清县县域医共体改革措施与效果分析

目的：分析浙江省德清县县域医共体改革措施及阶段性成效。方法：定性访谈了解医共体整合措施，定量分析医共体建设前后（2016-2018年）各级医疗机构医疗服务利用数据及医共体部分绩效考核数据。结果：医共体在组织、管理、功能、服务方面进行整合，并取得阶段成效：医保基金在县域内支出率有所增加；乡镇卫生院卫生人员数量、医疗收入有所提高，乡镇卫生院住院病人人均医药费有所降低。结论：医共体取得初期成效，应开展以患者健康结局指标为主的长期追踪调查，全面系统评估医共体；保留基层医疗机构地位、功能定位不变；探索实行医共体"总额预付、结余奖励"制度，将医共体发展成以患者健康为中心、基于利益共享机制、分工合作的责任利益共同体。     

Experiences,considerations and emotions relating to cardiogenetic evaluation in relatives of young sudden cardiac death victims

Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potentially fatal inherited cardiac disease. Hence, it is recommended to perform an autopsy on the victim and to refer his or her relatives to a cardiogenetics clinic for a full evaluation to identify those at risk and allow preventive measures to be taken. However, at present, the number of families attending a cardiogenetics clinic after the SCD of a young relative is low in the Netherlands. We performed a qualitative study and report on the experiences and attitudes of first-degree relatives who attended a cardiogenetics clinic for evaluation. In total, we interviewed nine first-degree relatives and one spouse of seven SCD victims about their experiences, considerations and emotions before attendance and at the first stage of the cardiogenetic evaluation before DNA results were available. Interviews were transcribed verbatim and analysed. Medical professionals did not have an important role in informing or referring relatives to a cardiogenetics clinic. Importantly, all participants indicated that they would have appreciated a more directive approach from medical professionals, because their mourning process hampered their own search for information and decision-making. A need to understand the cause of death and wanting to prevent another SCD event occurring in the family were the most important reasons for attending a clinic. There are possibilities to improve the information process and better support their decision-making. The multidisciplinary cardiogenetic evaluation was appreciated, but could be improved by minor changes in the way it is implemented.     

The hospital-acquired condition reduction program for colorectal surgery: Current initiatives and implications for the future

The 2010 Patient Protection and Affordable Care Act (PPACA)¹ sought to reform healthcare in the United States through a myriad of initiatives that included expanding health insurance accessibility, mandating coverage, revising and expanding a multitude of government programs, and incentivizing improved quality and value in healthcare delivery.² One initiative aimed at containing costs and improving patient outcomes is the Hospital-Acquired Condition Reduction Program (HACRP). Like the Hospital Readmission Reduction Program (HRRP), the goal of this program is to stratify hospitals based on their outcomes, in this case a composite score of multiple hospital-acquired conditions (HACs), and financially penalize the bottom performers. It is important for surgeons and hospitals understand the metrics behind these measures, and to lend a voice to the discussion of the benefits and alternative strategies to quality improvement.     

Six lessons from introducing sweetened beverage taxes in Berkeley,Cook County,and Philadelphia: A case study comparison in agenda setting and decision making

Sweetened beverage (SB) taxes have recently been introduced to prevent obesity by several governments, but limited information on related policy adoption processes hampers further diffusion. We investigated the agenda-setting and decision-making phases of SB tax reforms in Berkeley and Philadelphia (where it was successfully adopted), and Cook County (where it was repealed). A web-based survey, semi structured stakeholder interviews, and a local media coverage analysis were used to collect information. Findings were structured and analyzed using the health policy triangle of Buse, Mays and Walt. Six general lessons emerged. First, the policy was coupled to existing high-agenda items (e.g., financing pre-kindergarten in Philadelphia). Second, policy framing had to align prevailing political sentiments, as expressed in media (e.g., ‘Berkeley vs. Big Soda’ echoed skepticism of corporate influence in politics). Third, existing tax policies and political decision-making rules were important (e.g., confusion how the SB tax related to state and federal taxes fueled Cook County opposition). Fourth, the tax structure required technical and political considerations during policy formulation (e.g., artificially-sweetened beverages were included in Philadelphia to counteract arguments that the tax was regressive). Fifth, it was important to build an advocacy coalition upfront (e.g., the Berkeley coalition was constructed prior to announcing the attempt). Sixth, successful advocacy coalitions were locally grounded and influenced local media (e.g., the Cook County opposition engaged local retailers).     

School physical activity policies and associations with physical activity practices and behaviours: A systematic review of the literature

The development and implementation of school policies is considered a key strategy for the promotion of physical activity (PA) in children and adolescents. This study aimed to systematically review and synthesise existing literature focusing on the associations between formal written school-based PA policies and (a) school PA practices and (b) PA behaviours of school-aged children and adolescents. Fifty-one papers reporting on 52 studies met the eligibility criteria. All but two studies were from high income countries, most used cross-sectional designs and demonstrated fair methodological quality, and just over a third examined language aspects of policies. Findings predominantly indicated a lack of or inconclusive associations between the various characteristics examined and PA outcomes. Inconclusive associations were identified between both PA practice and behaviour outcomes and state level policies, policies focusing on PE and school-day PA, and in studies examining language aspects of policies. Inconclusive associations with both types of outcomes were more likely to be identified compared to a lack of associations in studies using self-report measures and in studies not providing information about the quality of exposure and outcome measures used. Overall, findings highlight the need for further research that acknowledges the complex relationship between school policies and PA outcomes and employs robust methodological approaches to enhance our understanding of this area.     

Claims in vapour device (e-cigarette) regulation: A Narrative Policy Framework analysis

BackgroundThe electronic cigarette or e-cigarette (vapour device) is a consumer product undergoing rapid growth, and governments have been adopting regulations on the sale of the devices and their nicotine liquids. Competing claims about vapour devices have ignited a contentious debate in the public health community. What claims have been taken up in the state arena, and how have they possibly influenced regulatory outcomes?MethodsThis study utilized Narrative Policy Framework to analyze the claims made about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the 2016 deeming rule legislation from the United States, and examined the claims and the regulatory outcomes in these jurisdictions.ResultsThe vast majority of claims in the policy documents represented vapour devices as a threat: an unsafe product harming the health of vapour device users, a gateway product promoting youth tobacco uptake, and a quasi-tobacco product impeding tobacco control. The opportunity for vapour devices to promote cessation or reduce exposure to toxins was very rarely presented, and these positive claims were not discussed at all in two of the four documents studied.ConclusionThe dominant claims of vapour devices as a public health threat have supported regulations that have limited their potential as a harm reduction strategy. Future policy debates should evaluate the opportunities for vapour devices to decrease the health and social burdens of the tobacco epidemic.