Objective The paper aims to analyze the current status and trends of non-local medical treatment in Shanghai, to explore the supply and demand characteristics of these patients, and to provide a basis for decision-making in improving the management of non-local medical care. Methods Based on the big data platform of the Shanghai Health Information Network, inpatient medical record face sheets from 2019 to 2023 were collected. The characteristics of patients residing outside of Shanghai, including inpatient service utilization, institutional distribution, and disease structure, were analyzed. Results From 2019 to 2023, the number of hospital admissions by patients from outside of Shanghai increased from 1.105 6 million to 1.345 4 million, accounting for 18.53% to 23.85% of the total hospital admissions in the city, with over 84% being admitted to tertiary hospitals. Patients from the Yangtze River Delta region accounted for more than 60%. Non-local patients mainly received cancer radiotherapy, chemotherapy, immunotherapy, and targeted therapy, accounting for over 40%. The average cost per hospitalization for cardiovascular diseases was relatively high. In terms of annual trends, the number of admissions to obstetrics and gynecology departments decreased by 21.74%, while pediatric admissions increased by 74.46%. Admissions to ophthalmology and otorhinolaryngology departments saw a modest increase. In contrast, admissions to the departments of oncology increased significantly, by 166.69%. Conclusions Disease severity and geographical accessibility are key drivers of non-local medical-seeking behavior. It is recommended to focus on establishing a rational and orderly diagnosis and treatment pattern for key diseases, and to establish a monitoring system for expenses related to non-local medical care.

Objective The study attempts to analyze the hospitalization patterns and characteristics of non-local patients with cancer in Shanghai, and to provide evidence for optimizing cross-regional medical care policies and guiding the strategic transformation of hospitals. Methods Dig data from the Shanghai Health Information Network were utilized to analyze the inpatient medical records (2019-2023) from all municipal medical institutions. Again, data of patients with cancer were extracted to systematically analyze the medical visit characteristics of non-local patients. Results From 2019 to 2023, hospital admissions for non-local patients with cancer increased from 444 900 to 548 900 person-times, with total costs rising from 10.535 billion yuan to 15.688 billion yuan. Over 60% of the non-local patients were from the Yangtze River Delta region, with patients from Jiangsu province accounting for more than 30%. The most common cancer types among non-local patients were digestive system malignancies (26.62%), respiratory system malignancies (20.93%), benign tumors (9.63%), and breast malignancies (7.88%). The primary treatment modalities were therapeutic surgeries and chemotherapy, with significant increases observed in targeted therapy and immunotherapy. Conclusions Cancer continues to be a major disease category driving cross-regional medical care. The balanced distribution of high-quality medical resources has reduced the need for cross-regional care. Leading hospitals in medical destination hubs urgently need to adjust their strategic positioning and transform their service development. Implementing Diagnosis Related Group (DRG) and Diagnosis-Intervention Packet (DIP) payment management for cross-regional medical services, covering both intra-provincial and inter-provincial care, is a crucial supporting measure for future reforms.

Objective This study aims to analyze the characteristics and patterns of the policy formulation process for cross-regional medical treatment in Shanghai, in order to better understand the inherent patterns and evolution of cross-regional medical treatment work, and to provide theoretical support for optimizing and refining the policy system. Methods A total of 64 policy documents related to cross-regional medical treatment in Shanghai were collected from databases such as PKU Law, the State Council Policy Document Database, and CNKI. Based on the four-dimensional analytical framework of “policy instruments-policy objectives-participating actors-external characteristics”, policy instrument theory and quantitative text analysis were applied to explore the developmental trajectory of Shanghai’s cross-regional medical treatment policies. Results Since the initiation of Shanghai’s cross-regional medical treatment policy in 2009, it has undergone four distinct stages: the initial exploration stage (2009-2015), the standardized promotion stage (2016-2019), the deepening development stage (2020-2022), and the high-quality development stage (2023-2024). Notably, the period from 2020 to 2022 witnessed the largest number of policy issuances (29 documents). Among the 64 policy texts, 16 departments were involved in policy formulation, with the Shanghai Municipal Healthcare Security Administration serving as the primary issuing body (42 documents). Of the 133 coded elements, environmental policy instruments accounted for the largest proportion (45.11%), followed by demand-side (28.58%) and supply-side instruments (26.31%). In terms of policy objectives, “enhancing convenience” hit most frequently (43.61%). Government departments were the dominant actors, representing 45.86% of both policy instruments and objectives. Conclusions Shanghai’s cross-regional medical treatment policies exhibit a “one-dominant, multiple-prominent” distribution pattern, forming a framework centered on environmental policy instruments, complemented by demand-side and supply-side instruments. The institutional development of cross-regional medical treatment in Shanghai has gradually evolved from a provider-centric model to a multi-stakeholder collaborative governance model. It is recommended that future efforts focus on strengthening interdepartmental coordination, increasing resource investment, optimizing supervision of medical insurance funds, and enhancing policy implementation capacity and service quality, to promote the efficient and sustainable development of cross-regional medical treatment policies in Shanghai.

Objective This study attempts to analyze the utilization of inpatient services by residents from Tianjin and Hebei seeking care at tertiary public hospitals in Beijing before and after the implementation of the direct settlement policy for cross-regional medical care, to explore the influencing factors of cross-regional hospitalization costs, and to provide scientific evidence for the subsequent implementation and optimization of this policy. Methods Data were extracted from the medical record face sheets of tertiary public hospitals in Beijing between 2016 and 2022. The number of inpatients from Beijing, Tianjin, and Hebei was calculated, and data on their demographics, disease characteristics, medical insurance types, and average cost per hospitalization were collected. A fixed-effects log-linear regression model was used to analyze factors influencing medical costs. Results Among cross-regional patients in Beijing’s tertiary public hospitals, the proportion of patients from Tianjin and Hebei increased from 26.13% in 2016 to 28.71% in 2022. Patients aged 40-69 accounted for 70.04%, and those covered by Employee Basic Medical Insurance accounted for 36.61%. 26.09% underwent treatments or procedures such as radiotherapy, chemotherapy, and postoperative rehabilitation, and over 20% were hospitalized in surgical departments. During the observation period, the average cost per hospitalization for patients from Tianjin and Hebei was 28 489.6yuan, which was approximately 20.67% higher than that for local Beijing patients (β = 0.188, P<0.01). Conclusions The cross-regional healthcare policy has facilitated the sustained growth in the number of patients from Tianjin and Hebei seeking medical care in Beijing. Distinct characteristics were observed in their demographic and disease profiles: predominantly working-age individuals (40-69 years old), with a relatively high proportion of Employee Basic Medical Insurance participants. Their diagnosis and treatment behaviors were significantly concentrated in high-resource consumption areas such as surgeries, radiotherapy, chemotherapy, and postoperative rehabilitation. Correspondingly, the average cost per hospitalization for patients from Tianjin and Hebei was significantly higher than that for local Beijing patients. Therefore, it is recommended to improve policies by promoting regional healthcare coordination, optimizing medical services for the elderly, and strengthening differentiated payment policies of medical insurance funds, to enhance the equity and sustainability of the cross-regional healthcare system.

Objective To analyze changes in gender, age distribution, and disease spectrum among Hong Kong and Macao residents hospitalized in Shenzhen, and to understand their inpatient demand in Shenzhen in order to provide evidence for building the “Healthy Greater Bay Area”. Methods A retrospective analysis was conducted on data from the medical record face sheets of Hong Kong and Macao residents hospitalized in Shenzhen between January 1, 2016, and December 31, 2024. Data on age, gender, and disease profiles were extracted and compiled using Stata MP17.0. Results From 2016 to 2024, a total of 25,779 hospital admissions of Hong Kong and Macao residents were recorded in Shenzhen. The majority of patients were female. The age distribution shifted from predominantly 30-44 years to predominantly 60 years and above. The number of inpatient admissions increased from 1,348 in 2016 to 11,676 in 2024. The top five disease categories among Hong Kong and Macao residents hospitalized in Shenzhen were: diseases of the genitourinary system (14.82%), neoplasms (10.70%), pregnancy, childbirth and the puerperium (9.70%), diseases of the digestive system (8.98%), and diseases of the eye and adnexa (8.59%). The rank of the top 10 diseases varied across years, genders, and age groups. Among Hong Kong and Macao residents admitted to Shenzhen, over 65% chose comprehensive or tertiary hospitals. Conclusions The inpatient demand of Hong Kong and Macao residents in Shenzhen is increasing, with a diversified disease spectrum. Patients showed a preference for tertiary comprehensive hospitals. It is recommended that Shenzhen continue to advance the construction of a “Healthy Greater Bay Area” by rationally allocating specialty resources and improving international medical service capabilities.

Objective The study attempts to explore the effectiveness, major problems, and optimization suggestions of China’s Volume-Based Procurement (VBP) policy for pharmaceuticals, and to provide reference for refining the VBP system and standardizing the full-process management of drugs. Method Using the Grounded Theory method, textual analysis was conducted on the interview transcripts of 19 interviewees through a three-stage coding process, including open coding, axial coding, and selective coding. Results The analysis of 266 representative raw statements yielded 48 initial categories. Following the three-level coding process, three core categories concerning VBP’s effectiveness were identified from the perspective of affected stakeholders: “Patients”, “Enterprises”, and “Medical Insurance”. Interviewees generally believed that VBP has created a “triple-win” situation for medical institutions, medical insurance, and patients. Regarding problems and suggestions, three core categories were distilled respectively: “Scope of Implementation”, “Core Objectives”, and “Operational Mechanisms”. Interviewees generally believed that the variety scope of VBP drugs needs to be further expanded, the supervision of the procurement process needs to be strengthened, coordination between national and local VBP programs is insufficient, and public demand for enhanced quality of VBP drugs is urgent. Conclusions Although the VBP policy has achieved certain outcomes in safeguarding patient core interests, standardizing clinical drug use, guiding industrial transformation, and improving the efficiency of the medical insurance system, operational challenges persist, including incomplete procurement coverage, inaccurate demand reporting, poor supply, and insufficient utilization for some drugs. It is recommended to continuously improve the VBP system, strengthen refined full-process management, ensure synergy between medical care, medical insurance, and pharmaceuticals, as well as vertical coordination, and reinforce price management and drug quality assurance, to provide the public with more cost-effective and reliable medicines.

Objective The study attempts to analyze the current situation and quality control of clinical trials of special drugs, and to explore strategies to improve their quality. Methods This study collected clinical trial data from the Drug Clinical Trial Registration and Information Disclosure Platform of the Center for Drug Evaluation (CDE) under China's National Medical Products Administration (NMPA) from 2021 to 2024, along with registration records of special drug clinical trial programs in a tertiary hospital. The analysis focused on the quantitative trends of these special drug trials, conducted a categorized statistical review of quality control measures and recurring issues across all trial phases and accountable parties. Additionally, through expert interviews, the research identified critical risk points in the clinical trial and investigated their underlying causes. Results From 2021 to 2024, China conducted 467 clinical trials for special drugs, and the study hospital accounted for 46 cases—approximately one-tenth of the national total. Trials involving toxic medical drugs and radioactive drugs showed steady annual growth, while those related to narcotic and psychotropic drugs exhibited fluctuating patterns. Among them, 22 underwent quality assessments with 58 issues identified during the process. The top four recurring problems were clinical trial data recording and reporting (27.6%), safety information processing and reporting (22.4%), investigational drug management (17.2%) and screening enrollment, and protocol execution (12.1%). Investigators were the most frequent source of management issues, with 38 reported cases. Experts attributed the primary risks to investigators’ over-reliance on Clinical Research Coordinators (CRC) and inadequate regulatory frameworks for special drug trials. Conclusions The number of clinical trial projects for special drugs at the study hospital shows varying annual trends depending on the drug type. Quality issues in these trials mainly involve errors and omissions in recording and drug management practices. To address this, it is essential to refine clinical trial management regulations, enhance investigators’ accountability awareness, and develop intelligent quality management platforms through digitalization.

Medical artificial intelligence (AI) has shown remarkable advantages in improving diagnostic efficiency and the quality of patient care. However, with the rapid adoption of AI technology in the medical industry, various tort cases have emerged frequently. In China, controversies exist regarding the determination of liability in medical AI tort cases, which are mainly reflected in the unclear legal status of the subjects of liability, the difficulty in determining the cause of the tort, and the uncertainty of liability imputation principles. This paper summarizes and analyzes domestic and foreign views on the subjects of AI liability and the suggestions regarding the regulatory dilemmas of medical AI tort liability in China. Drawing on the advanced experience and explorations of the United States, the European Union, Japan, and other countries, this paper proposes that China should improve the legal liability imputation system for medical damage on the basis of clarifying the legal status of medical AI. China should gradually clarify the legal status of liable subjects and refine the liability imputation principles for different scenarios, so as to balance the interests and responsibilities among patients, medical personnel, medical institutions, and designers and manufacturers of medical AI.

Objective The study aims to analyze the development status and trends of patents related to wearable devices in the global health management field, and to provide a reference for researchers in the field of wearable medical equipment. Methods Patents were retrieved from the IncoPat Global Technology Analysis and Operations Platform for the period from January 1, 2000, to December 17, 2024. Statistical analysis and visualization were conducted on dimensions such as patent application trends, geographical distribution, applicants, legal status, technology categories, technical efficacy, and keywords related to wearable devices in the global field of health management. Results A total of 4 270 patent documents were included, involving 4 270 patents. From 2000 to 2024, the number of patent applications for wearable devices in the global health management field exhibited a phased growth trend. Notably, China’s application trend in this field aligned with the global trend, showing rapid development in recent years to become the country with the most patent applications, followed by the United States, India, South Korea, and Japan. Technically, patents were primarily distributed in IPC classes A61B (Diagnosis; Surgery; Identification) and G16H (Healthcare Informatics, i.e., Information and Communication Technology for processing medical or health data). Major applicants included Samsung Electronics Co., Ltd., i4C Innovations Inc., Industrial Technology Research Institute, International Business Machines Corporation (IBM), and AliphCom. Regarding legal status, from 2000 to 2024, there were 2 208 patents in the authorized and published states, and 627 patents in the withdrawn and rejected states. Keyword cluster analysis indicated that “machine learning” was the most frequent term, followed by “health management”, “health monitoring”, “vital signs” and “smart wearables”. Conclusions The number of patent applications for wearable devices in the global health management field presents an overall phased growth trend, and China ranks first in the number of patent applications in this field. Currently, the R&D focus of wearable device technology is shifting towards intelligence and precision.

Objective This study aims to evaluate the clinical value of the locally deployed DeepSeek R1 model, developed by DeepSeek Inc., in multi-task oncology scenarios. Specifically, this research attempts to systematically assess its real-world performance in assisted diagnosis, treatment pathway recommendation, clinical trial matching, and medical record quality control, and to verify its feasibility and potential for implementation in smart hospital development. Methods Real-world data were collected from the Oncology Department of the Chinese PLA General Hospital of Xinjiang Military Command between May and August 2024. A locally deployed framework incorporating retrieval-augmented generation technology was constructed, followed by multi-scenario performance evaluations. In the assisted diagnosis task, 30 patients with gastric cancer were enrolled to compare the diagnostic performance between the DeepSeek R1 model and junior physicians. In the treatment recommendation task, another 30 patients with gastric cancer were included to evaluate the model’s capacity, relative to ChatGPT-4, in generating suggestions for comorbidity management, nutritional intervention, and dynamic treatment plan adjustment. For the clinical trial matching and doctor-patient communication tasks, 10 patients with non-small cell lung cancer were assessed to measure the model’s accuracy in enrollment recommendation and its effectiveness in enhancing patient communication. In the medical record quality control task, 50 retrospective medical records were reviewed to evaluate the model’s sensitivity in detecting logical inconsistencies. Results In the diagnostic task, the DeepSeek R1 group demonstrated a significantly higher diagnostic accuracy (96.7% vs. 76.7%, P = 0.008), lower misdiagnosis rate (6.7% vs. 20.0%, P = 0.039), and shorter diagnostic time compared to the junior physician group. In treatment recommendation, the DeepSeek R1 group outperformed the ChatGPT-4 group in identifying comorbidities and generating personalized treatment suggestions (100.0% vs. 13.3%, P<0.001), assessing nutritional risk and providing intervention plans (86.7% vs. 6.7%, P<0.001), and dynamically adjusting treatment strategies (93.3% vs. 0, P<0.001). The model achieved a clinical trial matching accuracy of 90%. In the communication and quality control tasks, the shared decision-making questionnaire score was significantly higher in the DeepSeek R1 group than in the conventional communication group (38.7 ± 2.8 vs. 21.3 ± 3.5, P<0.001), and the model demonstrated 91.7% sensitivity in identifying tumor staging inconsistencies. Conclusions Through localized deployment and multimodal data integration, the DeepSeek R1 model demonstrates substantial potential in supporting various oncology-related decision-making tasks. Therefore, it provides a cost-effective technological pathway for advancing smart hospital development.

In modern society, time poverty coexists with mental health crises, creating an urgent need for a mental health promotion model that is rooted in daily life, culturally inclusive, and practically operable. Through theoretical integration and deduction, this paper organically synthesizes Western empirical sciences, such as positive psychology and mindfulness-based cognitive therapy, with the “inward-seeking” wisdom of self-cultivation found in traditional Chinese culture, proposing the “Seven Dimensions of Time” theory. The theory posits that consciously enhancing the quality of seven dimensions—sleep time, exercise time, focus time, time in nature, connection time, reflection time, and introspection time—can effectively nourish psychological resources and facilitate the progression along the mental health continuum from “problem remediation” to “flourishing”. The “Seven Dimensions of Time” model emphasizes the individual’s proactive role in constructing daily life, offering a novel, time-anchored, and practice-oriented roadmap for mental health intervention that deeply integrates Eastern and Western cultures.

Objective This study attempts to investigate the effect of family intergenerational interaction on the prevalence of mild cognitive impairment (MCI) in rural seniors, and to provide a scientific basis for mitigating MCI through family intergenerational interaction. Methods An integrated multi-stage stratified and random sampling method was used to select 1897 seniors aged 60 years and above from 144 rural communities in Hunan Province. The Family Intergenerational Interaction Scale (FIIS) and Montreal Cognitive Assessment (MoCA) were used to measure intergenerational interaction levels and cognitive function in the sample families, respectively. And the stepwise regression was employed to explore the effect of family intergenerational interaction on MCI prevalence. Results A total of 357 MCI patients were identified with a prevalence rate of 18.82%. Across the four dimensions of family intergenerational interaction (economic, labor, cultural, and spiritual), both the moderate group (OR = 2.324, OR = 1.057, OR = 1.897, OR = 1.462) and the high group (OR = 2.157, OR = 2.038, OR = 2.221, OR = 1.965) were significantly negatively associated with the risk of MCI, compared with the low group (all P<0.001). Regarding individual characteristics, age≥75 years was associated with a higher risk of MCI in rural seniors, while educational attainment≥7 years, good self-rated health, and normal marital status were associated with a lower risk in this population (all P<0.001). Conclusions Rural seniors with less family intergenerational interaction (economic, labor, cultural, and spiritual) have a higher risk of developing MCI. Therefore, it is essential to strengthen multi-dimensional and diversified family intergenerational interaction.

Objective The paper aims to analyze the research hotspots and trends of tiered diagnosis and treatment in China, and to provide references for improving the theoretical and practical research on China’s tiered diagnosis and treatment system. Methods Journal articles related to tiered diagnosis and treatment included in the China National Knowledge Infrastructure (CNKI) database from 2012 to 2024 were searched. Data were exported in RefWorks format, and the included studies were analyzed using CiteSpace 6.1 R3 for bibliometric and visual analysis. Results A total of 6 198 valid articles were included. The annual publication output on tiered diagnosis and treatment in China initially increased and then decreased, peaking in 2018 with 1 143 articles and declining year by year after 2019. A core group of high-yield authors and strong collaborative research networks have not yet been formed. Keywords such as tiered diagnosis and treatment, medical consortia, two-way referral, and influencing factors appeared with high frequency and centrality. Research themes focused on tiered diagnosis and treatment, medical consortia, family doctors, and influencing factors. Emerging research frontiers included specialty alliances, medical-prevention synergy, artificial intelligence, knowledge graphs, and medical communities. Conclusions Future research should prioritize identifying emerging high-impact topics within the tiered diagnosis and treatment system. It is essential to strengthen interdisciplinary collaboration and team-based research, and to promote synergistic studies integrating tiered diagnosis and treatment with medical insurance and high-quality medical development.

Objective This study attempts to analyze the constraints on the policy implementation of China’s healthcare security agreement management, and to provide reference suggestions for enhancing the policy effect of healthcare security agreement management. Method Based on the Meter-Horn policy implementation model, the constraints on policy implementation of healthcare security agreement management were analyzed from six dimensions: policy standards and objectives, policy resources, inter-organizational communication and enforcement activities, characteristics of implementing agencies, system environment, and disposition of implementers. Result Constraints on the implementation of the healthcare security agreement management policies include: policy violations by the policy target group, the limited capacity of resource absorption and integration at the primary level, the underdeveloped communication and implementation procedures, the lack of internal motivation within implementing agencies, the insufficient strength of policy regulation, and the deviation in implementers’ compliance intentions. Conclusion To enhance the effectiveness of policy implementation in healthcare security agreement management, it is recommended to refine policy implementation standards, optimize the allocation of policy resources at the primary level, improve communication and implementation mechanisms, clarify the organizational structure of policy execution, establish a normalized supervision mechanism, and create a favorable policy environment to promote precise alignment and advance the high-quality development of the healthcare security system.

Objective This study aims to evaluate the impact of the pay-for-performance policy under the Diagnosis-Related Groups (DRG) system for dominant Traditional Chinese Medicine (TCM) diseases on patients’ medical expenses, hospital length of stay, hospital service volume, and efficiency. The empirical evidence obtained to support the scientific validity and feasibility of this payment method could offer a reference in deepening the reform of the medical insurance payment system. Methods This study selected a designated key development unit of a national TCM specialty as the research setting. The Difference-in-Differences (DID) model was used to analyze the differences in various indicators between insured patients (observation group) and non-insured patients (control group) before and after the implementation of the payment reform policy. Results A total of 713 cases were included, consisting of 296 cases before the policy implementation and 417 cases after. There were 475 cases covered by local medical insurance and 238 cases classified as others (including intra-provincial non-local, trans-provincial non-local, and self-pay). Following policy implementation, the average quarterly case numbers in both the observation group and the control group [(56.6 ± 16.77) cases and (26.80 ± 10.18) cases, respectively] were higher than those before implementation [(32.00 ± 5.02) cases and (17.33 ± 6.12) cases]. Conversely, the average total hospitalization costs [(9 641.73 ± 3 469.69) yuan and (13 827.50 ± 12 889.03) yuan] were lower than those before implementation [(15 952.75 ± 10 907.07) yuan and (17 967.68 ±16 787.22) yuan]. Additionally, the average length of hospital stay for both groups was lower, and the proportion of medical service income was higher than before the policy implementation. Before and after implementation, except for medical technology and nursing fees, the observation group showed a significantly greater reduction in other cost categories compared to the control group (β<0, P<0.05). However, there was no statistically significant difference in the change of hospital service volume between the two groups (P>0.05). Tests for parallel trends, placebo effects, and heterogeneity analysis confirmed that the results of the DID regression model were reliable. Conclusions The pay-for-performance policy for TCM significantly reduced the average total cost per case of dominant TCM diseases. Specifically, the costs of treatment, drugs, and consumables decreased most significantly. Consequently, the cost structure was optimized and hospital stay duration decreased to reach an enhanced hospital efficiency.

Objective The research aims to analyze the application of policy instruments in the current equalization policy of basic public health services in China and the equity dimensions they contain, aiming to provide reference for the formulation and optimization of related policies. Methods Based on quantitative analysis of policy texts, Nvivo 15 was used to code and process the basic public health service equalization policy documents. According to the connotations of the indicators, the coded items were incorporated into a three-dimensional framework of “Policy Instruments-Social Equity-Policy Targets”. The high-frequency words and weighted percentage in the policy texts were statistically analyzed to examine the frequency and characteristics of policy instrument usage, followed by a multidimensional cross-analysis. Results A total of 123 policy documents were included. In the word frequency statistics, words with a weighted percentage greater than 1% included "work", "management", "service", "healthcare", "health", and "system". Multi-dimensional cross-analysis showed that demand-side policy tools accounted for 16%, while environmental policy instruments accounted for 51.62%. Regarding the equity concepts embodied in the policies, equity of opportunity was the most common, reaching 61.43%, whereas perceived equity was relatively low at only 4.61%. The main targets of the policy instruments were the government and medical institutions, accounting for 45.47% and 26.2%, respectively, while medical personnel and social capital accounted for only 17.74% and 10.59%. Conclusions There are imbalances in the application of existing basic public health service policy instruments, which lean towards environmental policy instruments. The concept of equity within these policies mainly focuses on equity of opportunity on the supply side, with less consideration for residents’ perceptions. The government needs to dynamically balance the frequency of policy instrument usage, coordinate adjustments to the equity concepts, and strengthen the public’s perceived equity.

Objective The paper aims to analyze the current status of adult vaccination services in Shanghai, propose policy recommendations for existing problems, and to provide solutions for optimizing the adult vaccination service system. Method Data were collected from the Shanghai Comprehensive Vaccine Management and Vaccination Information System and questionnaire surveys to analyze the availability and uptake of adult vaccines, the provision of vaccination services, and clinic director’ attitudes toward the proposed changes in adult vaccination service models. Results There are 13 categories comprising 22 types of vaccines available for adults in Shanghai (excluding COVID-19 and yellow fever vaccines), which were primarily non-National Immunization Program (NIP) vaccines. From 2019 to 2023, the total number of doses administered to adults reached 12.048 3 million, showing a consistent year-on-year upward trend with an average annual growth rate of 27.33%. The vaccination rate for all types of vaccines among adults of all age groups remained below 50%. As of the end of March 2024, there were 432 vaccination clinics providing services for people aged 18 years and above, among which community health service centers accounted for the largest proportion (61.11%). On average, each vaccination clinic had 14.30 staff members, and 70.7% of the clinics had at least one licensed physician. The vaccination clinics were primarily set up to serve both adults and children, with 70.84% of them serving both populations. The survey showed that 85.31% of clinic directors considered it feasible for general practitioners (GPs) to recommend suitable vaccines to residents and prescribe vaccination recommendations; 89.81% supported expanding the scope of contracted family doctor services to include vaccine recommendations. However, 60.19% opposed the involvement of retail pharmacists within the jurisdiction in the vaccine management system. Conclusions The vaccination rate for adults needs to be further improved. The allocation of vaccination service resources was imbalanced among different districts. Attitudes toward the proposed adult vaccination service models varied among staff members. It is recommended to prioritize adult vaccination, strengthen vaccine recommendations, and optimize vaccination service models.

Objective To explore and evaluate the integrated health management model for patients with chronic diseases based on community outpatient clinical pathways, and to provide a basis for building a long-term, systematic, and continuous medical-preventive integration system for chronic disease health services. Methods Starting from October 2024, Xuhui District in Shanghai piloted an integrated health management model for patients with chronic diseases based on community outpatient clinical pathways. Data on the follow-up management of chronic disease outpatient services before the pilot (January to September 2024) and after the pilot (October 2024 to May 2025) were collected. Changes in service efficiency, management quality, and doctor-patient satisfaction before and after the pilot were analyzed and compared. Results The average monthly number of outpatient face-to-face visits increased from 766 to 2,299 after the pilot, and the average total time spent on comprehensive follow-up services per visit decreased by 20%. Following the pilot implementation, the proportion of outpatient face-to-face visits to total visits (48.79%) and the detection rate of blood pressure abnormalities through hypertension screening (6.08%) were both higher than those before the pilot (17.26% and 5.13%, respectively). Regarding satisfaction, the rate among contracted patients increased from 83.5% to 94.4%, showing statistically significant differences (χ² = 8,779.13, 10.44, 29.80; all P<0.01). The satisfaction rate of family doctors increased from 90.2% to 96.1%, but the difference failed to show statistically significant (P = 0.434). Conclusion The integrated health management model for patients with chronic diseases based on community outpatient clinical pathways has demonstrated preliminary effectiveness in improving service efficiency, enhancing management quality, strengthening patient medical compliance, and optimizing doctor-patient satisfaction.

Health equity is a core issue in global health governance. However, traditional Health Technology Assessment (HTA) frameworks have long been efficiency-oriented and often fail to adequately incorporate equity considerations, potentially exacerbating systemic health inequalities. This study systematically reviews the conceptual foundations of health equity, synthesizes internationally recognized evaluation frameworks, and analyzes their methodological characteristics and applicability. Results indicate significant differences in objectives and methodologies among existing equity frameworks. Specifically, the Equity Checklist for HTA (ECHTA) embeds equity analysis through phased checklists but faces high implementation complexity; in contrast, the Guidance on Priority Setting in Health Care (GPS-Health) emphasizes multidimensional equity criteria, making it suitable for resource-limited settings. Furthermore, the Institute for Clinical and Economic Review (ICER) framework prioritizes patient engagement and subgroup analysis, requiring high-quality data; while the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) framework relies on longitudinal evidence with a data-driven approach. To address China’s current lack of an HTA health equity evaluation framework, this study proposes a localized implementation pathway: integrating ECHTA processes with GPS-Health qualitative standards, and combining Distributional Cost-Effectiveness Analysis and subgroup identification to establish a “qualitative-quantitative” hybrid evaluation framework while advancing the construction of baseline health disparity databases. These findings provide theoretical support for constructing a health equity-oriented governance system, addressing structural contradictions between efficiency and equity, and advancing Universal Health Coverage (UHC) goals.