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Background The service capacity of primary care has improved in China. General practice also takes growing responsibility in the management of type 2 diabetes mellitus, but there are concerns about the paucity of evidence of the quality of care delivered. And there is an absence of systematic quality indicators of type 2 diabetes mellitus in general practice in China. This study aimed to develop a set of type 2 diabetes mellitus quality indicators to facilitate quality measurement in general practice in China. Methods Preliminary quality indicators were generated and refined by literature review and an expert consultation meeting. Two rounds of email-based Delphi survey and a consensus meeting were carried out to identify quality indicators. Delphi questionnaires with 43 indicators were sent to 30 participants in the first round. There were 16 general practitioners and 10 community health service center leaders from primary care, 3 endocrinologists and a primary care researcher in the first round. And 27 out of the 30 participants participated in the second round. The consensus meeting was held among 9 participants to refine the indicators and a last round of rating was carried out in the meeting. The indicators were rated in terms of importance and feasibility. The agreement criteria were defined as median ≥ 7.0 and ≥ 85.0% of ratings in the 7–9 tertile for importance; median ≥ 7.0 and ≥ 65.0, 70.0, 75.0% of ratings in the 7–9 tertile for feasibility respectively in the three rounds of rating. Results After 2 rounds of Delphi survey and the consensus meeting, total 38 indicators achieved consensus for inclusion in the final set of indicators. The final set of indicators were grouped into 7 domains: access (5 indicators), monitoring (12 indicators), health counseling (7 indicators), records (2 indicators), health status (7 indicators), patient satisfaction (2 indicators) and self-management (3 indicators). Conclusions A set of 38 potential quality indicators of type 2 diabetes mellitus in general practice were identified by an iterative Delphi process in Beijing, China. Preliminary approach for measurement and data collection were described. However, the indicators still need to be validated by testing in a further study.

China has been engaged in the process of reforming its health care system recently. The government has attempted to rebuild the referral system to lower cost and enhance equity of the medical services.This study was undertaken to evaluate the current status of mutual referral pilot programme, perceived factors that affect referral behaviour and changes that would improve the current referral process in Beijing.Using a cross-sectional study design, we sent a postal questionnaire to 138 urban district community health service (CHS) centres in Beijing. Questions were chosen from a formal consensus process based on a nominal group technique.One hundred twenty-five of 138 (90.6%) CHS centres responded to the survey. Seventy-six (61.8%) CHS centres reported that the mutual referral system was feasible. Twenty-six (21.1%) CHS centres reported that the mutual referral programme was running smoothly. Uncertainties of diagnosis/management and access to particular medical specialty interest or skills were the two most common factors that were suggested as affecting referral behaviour. The presence of a dedicated department to accept referrals in hospitals and the use of referral guidelines were the most preferred choices as likely to improve the current referral process.Since a system of gatekeeper role by GPs at CHS organizations has not been established in Beijing, most CHS doctors agree that to ensure the smooth operation of referrals, a dedicated department should be assigned by hospitals to receive referred patients. Official guidelines on referral should be developed, and health authorities should strengthen their supervision of referrals.

To evaluate the value of four chamber view, outflow tract view and color Doppler echocardiography for detecting the fetal congenital heart defects among high-risk populations. And to discuss the significance of screening congenital heart defects by three methods and select the suitable method for wider applications.The echocardiographic records of all pregnant women performed at our hospital from January 2006 to December 2007 were reviewed retrospectively by screening of clinical epidemiology. All cases received ultrasonic examinations. The abnormal cases with postnatal confirmation by echocardiogram or autopsy were included. The abnormalities detected in each view were analyzed and classified.A total of 52 fetuses with congenital heart defects were detected by gray scale sonography and color Doppler sonography in 1310 cases. Each specific cardiac defect had its typical finding in these three planes. The sensitivities of three methods were 61.5%, 88.5% and 96.1% respectively.Four chamber view, outflow tract view and color Doppler sonography have played an important role in screening fetal common congenital heart defects. Outflow tract view is easy to operate and it may be recommended as a suitable method.

Background The work of developing clinical practice guidelines began just a little more than ten years ago in China. Up to now, there have been few studies about them. Objectives To review and analyze the status of Chinese clinical practice guidelines in 1997–2007. Methods All Chinese guidelines from 1997–2007 were collected, and made a regression analysis, and a citation analysis for evaluating the impact of guidelines. To analyze the developing quality, the most influential guidelines were evaluated with AGREE instrument, and each guideline was evaluated to check for any updating. In order to analyze the objective and target population, all guidelines were classified and counted separately according to disease/symptom center, and whether towards specialists or general practitioners. Results 143 guidelines were collected. An exponential function equation was established for the trend in the number of guidelines. The immediacy index in every year was very low while the average citation rate was not. Both the percentages of highly cited and never cited were high. For the evaluation with AGREE, only the average score of clarity and presentation was high (89.9%); the remaining were much lower. Editorial independence scored 0. Only 27 (18.9%) of 143 guidelines, were found to be evidence-based. Only a few had ever been updated, with an average updating interval of 5.2 years. Only 2.1% were symptom-centered, and only 4.2% were aimed at general practitioners. Conclusion Much progress has been obtained for Chinese guidelines development. However, there were still defects, and greater efforts should be made in the future.