Objective:To explore means of process quality assessment for antibacterial drug utilization among a-cute appendicitis patients under the New Rural Cooperative Medical Scheme ( NCMS) through the use of the explicit method in order to provide evidence for the rationality of drug utilization in NRCMS. Methods: Data was collected from the NCMS information system of one county in Shandong Province from 2007 to 2011 and included 1 ,721 cases of acute appendicitis in county and town-level hospitals. The explicit method was employed, which adopted the ad-herence rate to represent drug process quality by comparing the actual antibacterial drug utilized with those recom-mended by quality standards. Descriptive statistics were used to analyze quantitative data with Excell2007, Microsoft SQL 2005 and SPSS 17 . 0 . Results: The average overall adherence rate from 2007 to 2011 was 22 . 4% ( SD =22. 3%) at the individual level. The overall adherence rate of township health centers was very low, between 14. 6%and 19. 6%, with no significant difference among the five years. The utilization of cephalosporin drugs was relatively stable at town-level hospitals, that is, third-generation cephalosporins was used most frequently, while cephalosporin, recommended by quality standards, was the least utilized in all five years. At county-level hospitals, fourth-genera-tion drugs were gradually substituted with second and third-generation drugs. Utilization of the recommended drug metronidazole of the nitromidazoles drug group decreased over time at both the town and county-level hospitals, and the drug was gradually substituted by tinidazole and ornidazole, especially in county-level hospitals. Conclusions:From 2007 to 2011 , the rationality of drug utilization was low in the NCMS designated hospitals at both town and county-level hospitals, particularly in town-level hospitals. The underuse of recommended quality standard drugs was the main issue at hand, and this situation experienced no significant changes during the study period.%目的：对新农合急性阑尾炎病人的抗菌药物利用过程质量进行客观评价，为新农合县乡两级定点医疗机构药物利用的规范性提供依据。方法：利用2007-2011年山东省某县新农合信息系统数据，共纳入县乡两级定点医疗机构1721例急性阑尾炎病人。采用客观评价法，将实际利用的抗菌药物种类与质量规范推荐的药物进行比对，计算相应符合率来代表药物利用过程质量。定量数据主要采用描述性统计分析方法，通过Excel 2007、Microsoft SQL 2005和SPSS17．0进行。结果：2007-2011年推荐抗菌药物的总体符合率为22．4%( SD=22．3%)。乡镇卫生院推荐抗菌药物的总体符合率在14．6%~19．6%之间，差异无统计学意义。五年间，头孢类药物利用在乡镇卫生院趋于稳定，利用率最高的为第三代头孢，第二代头孢(推荐药物)利用率最低；县级医院第四代头孢逐步被第二代头孢和第三代头孢所替代。甲硝唑(推荐药物)利用率低，逐步被替硝唑和奥硝唑取代，以县级医院最为明显。结论：新农合县乡定点医疗机构抗菌药物利用规范性较差，主要体现为推荐药物利用不足，被质量规范外药物替代，且其规范性在2007-2011年间无明显改善。
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