多维组态视域下消极防御性医疗影响因素分析  

Analysis of Influencing Factors of Negative Defensive Medicine from the Perspective of Multidimensional Configuration

作　　者：刘雅萍 刘俊萍 邹丹丹 赵娟 张环宇 刘沼悦 尹新乐 梁立波[1] Liu Yaping;Liu Junping;Zou Dandan;Liang Libo(School of Health Management,Harbin Medical University,Harbin,Heilongjiang,150081,China;不详)

机构地区：[1]哈尔滨医科大学卫生管理学院,黑龙江哈尔滨150081 [2]复旦大学附属金山医院,上海201508 [3]陆军军医大学第一附属医院,重庆400038

出　　处：《中国医院管理》2024年第7期11-15,共5页Chinese Hospital Management

基　　金：国家自然科学基金项目(71974049,71673073,72274047)。

摘　　要：目的通过探索消极防御性医疗行为产生的条件组态效应,解释消极防御性医疗的形成机制和因果路径,为消极防御性医疗行为提供系统化建议,从而提高卫生资源的合理利用率。方法采用必要条件分析和模糊集定性比较分析探究消极防御性医疗产生的条件组态,输出条件构型,进一步分析影响因素间的组态效应。结果体制机制、机构规范、社会文化、医患关系、自我效能是消极防御性医疗的前因条件,通过组态分析发现共有两种形成消极防御性医疗行为的原因构型,分别是环境传导型和效能—环境联合传导型,两条路径的总体一致性为0.830。结论减少消极防御性医疗行为应注重改善制度环境,提高医生自我效能,建立公平、合理的外在制度环境,营造诚信、和谐的文化氛围,加强医生职业能力的培养以及改善医患关系,从而提高卫生资源的合理利用。Objective By exploring the conditional configuration effect of negative defensive medicine behavior,the formation mechanism and causal path of negative defensive medicine are explained,and systematic suggestions are provided for negative defensive medicine behavior,so as to improve the rational utilization of health resources.Methods NCA and fsQCA are used to conduct configuration analysis on factors influencing passive defensive medical behavior,output the conditional configuration,and further analyze the configuration effects among the influencing factors.Results The antecedent conditions of negative defensive medicine include systemic mechanisms,institutional norms,social culture,doctor-patient relationships,and self-efficacy.Ultimately,two paths contributing to passive defensive medical behavior emerge:environment conduction type and efficiency-environment joint conduction type,their consistency is 0.830.Conclusion To reduce the negative defensive medical behavior,it should pay attention to improving the institutional environment and improving doctors'self-efficacy,establish a fair and reasonable external institutional environment,create an honest and harmonious cultural atmosphere,strengthen the training of doctors'professional ability and improve the doctor-patient relationship,so as to improve the rational use of health resources.

关 键 词：消极防御性医疗 影响因素 组态 

分 类 号：R197.3[医药卫生—卫生事业管理]