四川省住院患者空间流向及其影响因素分析  

Analysis of the Inpatient Spatial Flow and Influencing Factors in Sichuan Province

作　　者：敖露 刘潇 潘杰[1,2] 宋超 王秀丽 Ao Lu;Liu Xiao;Pan Jie(West China School of Public Health/West China Fourth Hospital,Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西公共卫生学院·四川大学华西第四医院,四川成都610041 [2]四川大学公共管理学院,四川成都610041

出　　处：《中国医院管理》2024年第4期44-50,共7页Chinese Hospital Management

基　　金：国家自然科学基金项目(72204175,42071379);四川省自然科学基金面上项目(2022NSFSC0642)。

摘　　要：目的分析住院患者跨区县就医现状,并从流入地和流出地2个维度分析其影响因素。方法以四川省作为研究区域,利用2019年第四季度病案首页数据,分别以患者所在区县、住院机构所在区县、流动患者数量作为空间流向的起点、终点和强度分析患者空间流向,并结合患者个人层面、医疗机构层面及区县层面的信息,从流入和流出的维度建立两水平随机截距logistic回归分析探究其影响因素。结果四川省跨区县就医占比22.90%,千人以上流向集中在东部地区,但西部地区跨区县就医患者比例更高。成都、绵阳同时是最大的患者流出地和流入地。患者层面汉族(49%,P<0.001)、男性(2%,P<0.001)、稳定的收入(6%,P<0.001)、更好的医疗保障(16%,P<0.001),机构层面更好的资源,区县层面更高的经济(20%,P<0.001)和医疗水平(5%,P<0.001)会促进患者跨区县就医。结论四川省跨区县住院患者从周边流向区县中心,也从各地流向成都。全面推进分级诊疗,促进患者合理就医,应从加强患者健康教育、提高机构服务水平和促进经济与医疗协调发展等多个方面进行协同。Objective To analysis the current situation of hospitalized patients seeking medical treatment across different counties and the influencing factors from both the inflow and outflow perspectives.Methods Using the fourth quarter data of 2019 from the medical record index,with Sichuan Province as the research area,it analyzed the spatial flow of patients based on the patient’s county of residence,the county where the hospital is located,and the number of mobile patients.By combining information at the individual patient level,healthcare institution level,and county level,it established two-level random intercept logistic regression analysis to explore the influencing factors from the perspectives of inflow and outflow.Results The proportion of patients seeking medical treatment across different counties in Sichuan is 22.90%.The majority of patients,with a population of over one thousand,are concentrated in the eastern region.However,the western region has a higher proportion of patients seeking medical treatment across counties.Chengdu and Mianyang are both the largest sources and recipients of patient flows.Being Han Chinese(49%,P<0.001),male(2%,P<0.001),Stable income(6%,P<0.001)and better medical insurance coverage(16%,P<0.001)at the patient level,as well as better healthcare resources at the institutional level,and higher economic(20%,P<0.001)and medical levels(5%,P<0.001)at the district and county level promote patients seeking medical treatment across counties.Conclusion Hospitalized patients in Sichuan Province tend to seek medical treatment from surrounding counties towards the county centers,as well as flowing to Chengdu from various locations.Promoting hierarchical medical treatment and encouraging patients to seek appropriate medical services can be achieved through strengthening patient health education,improving healthcare service levels,and promoting coordinated development between the economy and medical industry.

关 键 词：患者空间流向 跨区县就医 县域内住院率 

分 类 号：R197.1[医药卫生—卫生事业管理]