老年共病患者共同决策及偏好与家庭医生签约服务质量关联性的网络分析  

Network analysis of correlation between shared decision-making or preferences and the quality of family doctor contracted services among elderly comorbidity patients

作　　者：熊巨洋[1] 马赫 XIONG Juyang;MA He(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science&Technology,Wuhan,Hubei Province 430030,China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北省武汉430030

出　　处：《中国慢性病预防与控制》2024年第12期937-942,共6页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：华中科技大学2023年自主创新基金文科重点项目(2023WKYXZD005);华中科技大学2024-2026学科建设项目(X20242501)。

摘　　要：目的采用网络分析法,厘清老年共病患者决策偏好、共同决策与家庭医生签约服务质量间的关系,为倡导共同决策理念,推动签约服务高质量发展提供参考。方法于2023年7至9月,分阶段随机抽取在湖北省武汉市和贵州省贵阳市的4个辖区12家社区卫生服务中心签约的60岁及以上患有2种及以上慢性病的患者为研究对象,采用家庭医生签约服务质量评价量表、SDM-Q-9共同决策量表、中文版决策倾向性量表(CPS)等工具进行问卷调查。利用R 4.2.2软件进行混合图模型(MGM)及有向无环图(DAG)分析,探索共同决策对签约服务质量的偏相关性及因果关系。结果调查对象中10.52%偏好主动决策,21.87%偏好合作决策,67.61%偏好被动决策。SDM-Q-9和家庭医生签约服务质量评价量表的Cronbach'sα依次为0.927和0.852,总得分均值依次为(32.065±6.460)和(95.285±8.739)分。网络分析结果表明,共同决策水平是签约服务质量网络的核心变量(强度z值=1.126,中介中心性z值=2.021,紧密中心性z值=0.953)。DAG与MGM网络结构及关系强弱基本一致,老年共病患者决策参与偏好(r=0.616)、近一个月是否利用签约服务(r=0.536)影响共同决策水平,共同决策水平直接影响签约服务的横向连续性(r=0.938)、纵向连续性(r=0.675)、综合性(r=0.962)和技术性维度(r=0.982)。结论高水平共同决策有助于提升老年共病患者签约服务质量,社区应率先倡导“共同决策”理念,助力签约服务高质量发展。Objective To clarify the relationship between decision-making preference or co-decision and contracted service quality of family doctor in elderly comorbidity patients using network analysis,and provide the reference for advocating the concept of common decision-making and promoting the high-quality development of contract services.Methods From July to September 2023,the patients(>60 years old)with two or more chronic diseases who were signed up at 12 community health service centers in 4 districts of Wuhan city in Hubei Province,and Guiyang city in Guizhou Province,were selected as the subjects.The investigation was performed with the questionnaire including the Family Doctor Contract Service Quality Evaluation Scale,SDM-Q-9 Shared Decision-Making Scale,and Chinese version of decision making tendency(CPS).The R 4.2.2 software was used to analyze the mixed graphical models(MGM)and directed acyclic graphs(DAG)to explore the partial correlation and causal relationship of joint decision-making on contracted service quality.Results Among the subjects,10.52%of subjects preferred active decisionmaking,21.87% of subjects preferred collaborative decision-making,and 67.61%of subjects preferred passive decision-making.The Cronbach's α for SDM-Q-9 and the Family Doctor Contract Service Quality Evaluation Scale were 0.927 and 0.852,respectively;overall mean scores were 32.065±6.460 and 95.285±8.739,respectively.Network analysis results indicated that the shared decision-making level was a central variable in the signing up for the service quality networks(strength z-score=1.126,intermediary centrality z-score=2.021,closeness centrality z-score=0.953).The DAG and MGM structures and relationships were largely consistent.Decision preferences of elderly patients with comorbidities(r=0.616)and whether they utilized contract services in the past month(r=0.536)influenced the shared decision-making levels.Shared decision-making level directly impacted the horizontal continuity(r=0.938),longitudinal continuity(r=0.675),comprehensi

关 键 词：老年共病 决策偏好 家庭医生 签约服务质量 网络分析 

分 类 号：R197[医药卫生—卫生事业管理]