江苏省新沂市紧密型县域医疗共同体内就诊患者转诊状况及其影响因素  

Status and Influencing Factors of Patient Referral Within Medical Community in Compact County of Xinyi City of Jiangsu Province

作　　者：何檬 胡传峰 郑瑞呢 关雪凌 黄文昊 沈良 覃朝晖 HE Meng(School of Management,Xuzhou Medical University,Xuzhou,Jiangsu,221004,China)

机构地区：[1]徐州医科大学管理学院,江苏徐州221004 [2]徐州市卫生健康委员会,江苏徐州221018 [3]徐州医科大学医疗卫生应急救援研究中心,江苏徐州221004

出　　处：《医学与社会》2023年第12期66-72,共7页Medicine and Society

基　　金：江苏省社会科学基金项目,编号为20GLB006;江苏省高校哲学社会科学重大项目,编号为2021SJZDA136;徐州市卫生健康委员会项目,编号为KY27011901。

摘　　要：目的:分析江苏省新沂市紧密型县域医疗共同体内就诊患者的转诊状况及其影响因素,为完善县域医共体转诊制度提供建议。方法:采用分层整群抽样方法在新沂市县域医共体内抽取20家基层医疗机构的1068名就诊患者进行问卷调查,通过随机森林模型和logistic回归分析县域医共体内就诊患者转诊的影响因素。结果:新沂市紧密型县域医共体内就诊患者的转诊率为12.6%。随机森林模型显示,变量数为11时的袋外估算误差率最低。重要性排名前11的变量依次为医疗费用、县域医共体知晓度、文化程度、常见病首选医疗机构、到达最近综合医院所需时长、年龄、到达基层医疗机构所需时长、医保制度知晓度、本次就医所选医疗机构、患病对生活影响程度和自评健康状况;logistic回归显示,县域医共体知晓程度为一般(OR=2.235)和较了解(OR=12.579)、医疗费用在3001-5000元(OR=2.371)和5001元以上(OR=4.786)、认为患病对日常生活影响一般(OR=1.834)和影响很大(OR=3.043)的患者对转诊服务利用更多。结论:新沂市县域医共体内就诊患者的转诊率不高,影响患者转诊的因素包括县域医共体知晓程度、医疗费用和患病对生活影响程度。建议创新政策宣讲方式,提升就诊患者的县域医共体知晓度,以增强患者科学转诊意识;建立合作转诊机制,鼓励医疗机构间相互分工协作,以实现就诊患者在县域医共体内有序转诊和科学分流。Objective:To analyze the referral status and its influencing factors of patients in compact county medical community in Xinyi city of Jiangsu province,so as to provide suggestions for improving the referral system of medical community.Methods:The stratified cluster sampling method was utilized to select 1068 patients from 20 grassroots medical institutions in Xinyi county medical community via the questionnaire survey.The random forest model and logistic regression were employed to analyze the influencing factors of referral behavior of patients in the medical community.Results:The referral rate of patients in the Xinyi county medical community was 12.6%.The results of random forest model showed that the out-of-bag estimation error rate reached the lowest when the number of variables was 11.The top 11 variables in order of ranking included medical expenses,the awareness about medical community,literacy,type of medical facility preferred for treating common illnesses,time taken to reach the nearest general hospital,age,time taken to reach the grassroots medical institutions,knowledge of the health insurance system,choice of medical facility for this visit,and impact of illness on life.The results of logistic regression analysis showed that the patients who had the average and more awareness level of the medical community(OR=2.235,OR=12.579),the 3001-5000 yuan and more than 5001 yuan of medical expenses(OR=2.371,OR=4.786),as well as the general and significant perceived impact level of illness on daily life(OR=1.834,OR=3.043),made more use of referral services.Conclusion:The referral rate of patients within the Xinyi county medical community is not high,and the factors affecting patient referral include the awareness about medical community,the medical expenses and the impact of illness on life.It is recommended to enhance the recognition of scientific referrals among patients through innovating the ways of policy advocacy and improving the awareness about medical communities.To achieve the orderly referral and sci

关 键 词：紧密型县域医共体 患者 转诊 影响因素 江苏 新沂 

分 类 号：R-05[医药卫生]