分级诊疗体系中医生协作意愿与行为的和谐驱动机制研究  

Research on the harmonious driving mechanism of doctors′collaboration willingness and behavior in the tiered diagnosis and treatment system

作　　者：钱宇[1] 王小合[1] 方欣[2] 王雨清 陈小雨 彭志毅 陆贝茵 Qian Yu;Wang Xiaohe;Fang Xin;Wang Yuqing;Chen Xiaoyu;Peng Zhiyi;Lu Beiyin(School of Public Health,Hangzhou Normal University,Hangzhou 311121,China;Department of Medical Affairs,Hangzhou First People′s Hospital,Hangzhou 310006,China;School of Management,Beijing University of Traditional Chinese Medicine,Beijing 100029,China)

机构地区：[1]杭州师范大学公共卫生学院,杭州311121 [2]杭州市第一人民医院医务部,杭州310006 [3]北京中医药大学管理学院,北京100029

出　　处：《中华医院管理杂志》2023年第4期274-280,共7页Chinese Journal of Hospital Administration

基　　金：国家自然科学基金(71974050,72274051)。

摘　　要：目的探究分级诊疗体系中医生协作意愿与协作行为的驱动机制,为推进分级诊疗服务体系建设及政府决策提供参考依据。方法基于和谐管理理论构建分级诊疗体系医生协作行为驱动机制理论框架。采用随机抽样的方式,于2022年4—5月对浙江省5个地级市40家医疗机构的医生进行问卷调查。采用t检验、方差分析、非参数检验分析不同人口学特征的医生协作意愿与协作行为的差异情况,运用结构方程模型与分层线性回归分析和则因素(职业环境、工作期望)与谐则因素(政策支持感知、管理机制感知)对医生协作意愿与行为的驱动机制。结果共有效调查医生1959人。医生协作行为得分为(2.13±1.12)分,处在中等偏下水平;医生协作意愿得分为(3.88±0.79)分,处在一般与较愿意之间。不同医疗机构等级、年龄、工作年限、月平均收入、职称医生的协作行为得分差异有统计学意义(P值均<0.05)。和则因素与谐则因素直接影响医生协作意愿,标准化路径系数分别为0.428、0.139;和则因素与谐则因素直接影响医生协作行为,标准化路径系数分别为0.104、0.366。政策支持感知、管理机制感知对医生协作意愿与协作行为之间关系具有显著的正向调节效应(P值均<0.05)。结论和则要素与谐则要素在意识与行为双层面对分级诊疗体系内医生间的协作具有正向驱动作用,政策支持与管理机制因素的加持及优化有利于不同层级医疗机构医生之间的协作由意识层面向行为层面转变。Objective To explore the driving mechanisms of doctors′collaborative willingness and behavior in the tiered diagnosis and treatment system,in order to provide reference for promoting the construction of the tiered diagnosis and treatment system.Methods Based on the harmonious management theory,a theoretical framework for the driving mechanisms of doctors′collaborative behavior in the tiered diagnosis and treatment system was developed.Through random sampling,a questionnaire survey was conducted among doctors from 40 medical institutions in five prefecture-level cities in Zhejiang province between April and May 2022.The t-test,variance analysis,and non-parametric tests were employed to analyze the differences in collaborative willingness and behavior among doctors based on various demographic characteristics.The structural equation model and stratified linear regression were used to assess the impact of collaborative factors(professional environment and work expectations)and harmonious factors(perception of policy support and perception of management mechanism)on doctors′collaboration willingness and behavior.Results A total of 1959 doctors participated in the survey.Doctors′collaborative behavior scored 2.13±1.12,indicating a slightly below-average level,whereas their willingness to collaborate scored 3.88±0.79,falling between neutral and somewhat willing.Significant differences in collaborative behavior scores were observed based on the medical institution′s ranking,age,years of experience,monthly average income,and professional titles(P<0.05).Both collaborative and harmonious factors directly influenced the doctors′willingness to collaborate,with standardized path coefficients of 0.428 and 0.139,respectively.Similarly,these factors directly impacted their collaborative behavior,with standardized path coefficients of 0.104 and 0.366.The perceptions of policy support and management mechanisms demonstrated a significant positive moderating effect on the relationship between doctors′collaborative wi

关 键 词：医生协作行为 医生协作意愿 分级诊疗体系 和谐管理理论 结构方程模型 

分 类 号：R197.323[医药卫生—卫生事业管理]