研究背景：中国作为一个发展中的农业大国，农村医疗卫生服务担负着农村居民卫生保健的重要任务。村级卫生室是农村医疗卫生服务的基本场所，本应是解决农村居民常见的健康问题主要的场所。但是，长期以来村级卫生室场地狭小、设施配备落后、医务工作人员水平不高等因素严重制约着村级卫生室的服务发展。由于缺乏有效的管理，开大方、药物滥用现象严重，普遍存在抗生素、激素使用率较高的情况，威胁着农村居民的健康。为此，各地开展了一系列改革来改善农村的医疗服务现状。胶南市在村级卫生室全面建立基本药物制度的基础上，强化资金投入，开展“处方点评”制度，进行村级卫生室的监督和管理，以规范乡村医生的医疗行为。研究目的：评价胶南市建立处方点评制度对村级卫生室门诊药费和合理用药的作用。研究方法：将胶南市123处村级卫生室作为研究对象，选取电子信息系统中处方点评实施前和实施后共22个月的门诊处方数据的统计值作为研究样本，采用非随机简单时间序列设计的类实验方法，利用分段回归的分析方法，分析处方点评制度实施的效果以及改革带来的持续性变化。由于时间序列数据具有序列相关性，因此使用广义差分法消除序列相关带来的影响，并采用普莱斯-温斯特变换解决样本观测值损失的问题。研究结果：在控制了时间序列数据的序列相关和季节性等因素的影响后，结果表明在2011年9月实施处方点评制度后，门诊药费下降1.1元（P=0.019），实施的长期效果是增加的，但是并不显著。处方点评制度的实施使抗生素处方比例下降5.78个百分点（P=0.086），长期来看，抗生素处方比例每月下降1.37个百分点。改革使针剂处方比例降低了9.75个百分点（P=0.001），长期效果也是逐渐降低，平均每月减少0.80个百分点。但是处方点评制度的开展并没有有效改变激素处方的使用，但是长期效果显著，激素处方比例平均每月减少1.73个百分点（P=0.003）。研究结论：胶南市在村级卫生室开展的处方点评制度改变了村级卫生室的医疗质量，通过乡村医生例会、培训辅导等措施逐步从观念上改变乡村医生的处方模式，形成促进乡村医生行为改变的支持环境，促进了药物的合理使用水平，降低了次均处方药费，促进了村级卫生室的基本医疗服务的功能的落实和发展。

Introduction: As a developing country based on agriculture, the rural population accounts for more than half of the total population of the country. The rural clinics should be responsible for rural health care, but for a long time the development of the rural clinics are restricted with many objective conditions, such as backward facilities, poor level medical personnel, and so on. Due to the lack of valid management, inappropriate use of antibiotics, hormones higher usage is widespread. It is serious threat to the health of rural residents. In order to improve rational use of medicines, an intervention was carried out to change the situation in Jiaonan district.Objective: This study was to evaluate the impacts of peer review on the cost of outpatient visit and rational use of medicines of rural clinics in Jiaonan district.Methods: Data was extracted covering 22 months period, before, during and after peer review in rural clinics. Segmented regression analysis with interrupted time series data was used to examine whether there had been a significant relationship between the onset program in September 2011 and the levels of outpatient cost, antibiotics use, hormones use and injection use. This study also controls for both serial and 1-month lag autocorrelations.Results: The results represent that the Peer Review Reform decrease expenses per outpatient visit on average by almost 50 percent, but has no the long-term effect. The intervention has effects on the overall drug use in outpatients. The changes in slope of the time series were -5.78 percent（P=0.086） on the percentage of encounters with antibiotics, -9.75 percent（P=0.001） on the percentage of encounters with injections, and 0.41 percent（P=0.278）on the percentage of encounters with hormones, which is the lower 95% CI of effect size assuming that the intervention has the immediate effect of the intervention. However, the percentage of encounters with antibiotics would not have continued to decrease by 1.37 percent steadily without the intervention, so does the percentage of encounters with injections by 0.80 percent. It also lowers 1.73 percent on the percentage of encounters with hormones per month after the intervention.Conclusion: The peer review reform was related with decreases in rational drug use and outpatient cost in 12 months after it was started. The peer review reform in Jiaonan district has positive effects on outpatient cost and rational drug use.