城市医疗集团康复患者向下转诊意愿及影响因素

doi:10.3969/j.issn.1006-9771.2023.12.013

摘要/Abstract

摘要：

目的调查城市医疗集团康复患者向下转诊的意愿，分析影响因素。

方法 2023年6月至10月，采用简单随机抽样方法，对某地城市医疗集团内医院神经康复和骨科康复患者开展调查。采用安德森模型2013版构建康复患者向下转诊意愿及影响因素理论框架，在该框架下采用Likert 5级评分量表设计问卷，问卷包含被调查者的个人特征、环境特征和医疗服务利用选择共3部分23项题目，开展预调查并通过信效度检测。

结果共收回问卷350份，获得有效问卷314份。康复患者向下转诊意愿与年龄、病种类型、康复期、向下转诊经历、对双向转诊政策的了解和必要性的看法、对城市医疗集团的了解和必要性的看法有关(χ² > 7.755, P < 0.05)；康复病种类型、康复期、是否有过向下转诊经历、对双向转诊政策必要性的看法是主要影响因素(P < 0.05)。

结论康复患者向下转诊意愿受病种类型、康复期、向下转诊经历、对双向转诊政策必要性的看法4个主要因素影响。应根据城市医疗集团康复患者向下转诊意愿的具体情况和主要影响因素制定更有针对性、更加聚焦的改进措施，不断提高愿意向下转诊的患者占比，有效落实康复患者双向转诊。

关键词: 康复, 向下转诊, 影响因素, 城市医疗集团

Abstract:

Objective To investigate the willingness of rehabilitation patients within an urban medical group to accept downward referrals and analyze the influencing factors.

Methods From June to October, 2023, a survey was conducted using a simple random sampling method among neurological and orthopedic rehabilitation patients in hospitals within a specific urban medical group. The 2013 version of the Andersen Model was employed to construct a theoretical framework for the willingness of rehabilitation patients to accept downward referrals and influencing factors. Within this framework, a questionnaire was designed using a 5-point Likert scale, comprising three sections including personal characteristics, environmental features and healthcare service utilization choices, totaling 23 questions. A preliminary survey was conducted, and the questionnaire had underwent reliability and validity testing.

Results A total of 350 questionnaires were collected, with 314 valid questionnaires. The willingness of rehabilitation patients to accept downward referrals was found to be associated with age, rehabilitation specialties, rehabilitation phases, previous experiences with downward referrals, awareness of and perceptions regarding bidirectional referral policies, and understanding and opinions about the urban medical group (χ² > 7.755, P < 0.05). The primary influencing factors were rehabilitation specialties, rehabilitation phases, previous experiences with downward referrals and perceptions of the necessity of bidirectional referral policies (P < 0.05).

Conclusion Rehabilitation specialties, rehabilitation phases, previous experiences with downward referrals and perceptions of the necessity of bidirectional referral policies are the primary factors that influenced the willingness of rehabilitation patients to accept downward referrals. We should formulate targeted and focused improvement measures based on the specific circumstances and key influencing factors of rehabilitation patients within the urban medical group regarding their willingness to accept downward referrals. Continuously enhancing the proportion of patients willingness to accept downward referrals is essential for the effective implementation of bidirectional referral for rehabilitation patients.

Key words: rehabilitation, downward referral, influencing factors, urban medical group

中图分类号:

R493

李经宇, 吕云, 辛雨, 李硕, 彭思静, 密忠祥. 城市医疗集团康复患者向下转诊意愿及影响因素[J]. 《中国康复理论与实践》, 2023, 29(12): 1481-1488.

LI Jingyu, LÜ Yun, XIN Yu, LI Shuo, PENG Sijing, MI Zhongxiang. Downward referral willingness of rehabilitation patients in an urban medical group and its influencing factors[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(12): 1481-1488.

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项目		n	构成比/%
性别	男	175	55.7
	女	139	44.3
年龄/岁	< 39	72	22.9
	40~59	139	44.3
	> 60	103	32.8
婚姻状况	未婚	33	10.5
	已婚	262	83.4
	离异或丧偶	19	6.1
学历	初中及以下	163	51.9
	高中/中专	76	24.2
	本科/大专及以上	75	23.9
职业	工人	116	36.9
	农民	71	22.6
	企事业单位工作人员	30	9.6
	其他	97	30.9
月收入/元	< 2000	118	37.6
	2000~5999	153	48.7
	> 6000	43	13.7
长期居住地	云冈区	190	60.5
	本市其他行政区县	85	27.1
	外市及外省	39	12.4
医疗付费方式	城镇职工基本医疗保险	145	46.2
	城乡居民基本医疗保险	117	37.3
	全自费	27	8.6
	其他	25	8.0
日常照料人	家庭成员	265	84.4
	付费护工	33	10.5
	其他	16	5.1

认为非常重要的原因	n	构成比/%
报销比例高/花费较少	143	45.5
转诊流程便捷	108	34.4
医生建议	105	33.4
离家近	103	32.8
对下级医疗机构比较熟悉	89	28.3

认为非常重要的原因	n	构成比/%
担心病情加重	165	52.5
担心医生水平	152	48.4
担心设施设备	151	48.1
担心转诊过程麻烦	136	43.3
担心距离和交通	131	41.7

项目		愿意	不愿意	χ²值	P值
年龄/岁	< 39	33	39	7.755	0.021
	40~59	56	83
	> 60	60	43
病种类型	神经康复	76	36	29.071	< 0.001
病种类型	骨科康复	73	129	29.071	< 0.001
康复期	急性期	44	64	12.719	0.004
	稳定期	3	12
	恢复期	100	82
	后遗症期	2	7
向下转诊经历	有	39	16	14.714	< 0.001
向下转诊经历	没有	110	149	14.714	< 0.001
对双向转诊政策的了解程度	非常了解	20	5	21.846	< 0.001
	了解	37	27
	不确定	28	24
	不了解	57	98
	非常不了解	7	11
对双向转诊政策必要性的看法	非常没必要	32	12	34.070	< 0.001
	没必要	49	34
	不确定	62	87
	有必要	6	24
	非常有必要	0	8
对城市医疗集团的了解程度	非常了解	24	9	21.594	< 0.001
	了解	43	31
	不确定	27	31
	不了解	54	85
	非常不了解	1	9
对城市医疗集团建设必要性的看法	非常没必要	33	23	15.944	0.003
	没必要	69	56
	不确定	43	72
	有必要	4	11
	非常有必要	0	3

项目	β	S.E.	χ²值	P值	Exp(β)	95%CI
项目	β	S.E.	χ²值	P值	Exp(β)	下限	上限
病种类型
骨科康复
神经康复	1.399	0.289	23.378	< 0.001	4.05	2.297	7.139
康复期
急性期
稳定期	-1.822	0.788	5.345	0.021	0.162	0.034	0.758
恢复期	0.199	0.287	0.481	0.488	1.221	0.695	2.143
后遗症期	-1.191	0.878	1.841	0.175	0.304	0.054	1.698
向下转诊经历
没有
有过	1.226	0.37	10.978	0.001	3.408	1.650	7.040
对双向转诊政策必要性的看法
非常有必要
有必要	-0.902	0.449	4.041	0.044	0.406	0.168	0.978
不确定	-1.618	0.419	14.946	< 0.001	0.198	0.087	0.450
没必要	-2.981	0.644	21.437	< 0.001	0.051	0.014	0.179
非常没必要	-21.620	13917.868	< 0.001	0.999	< 0.001	< 0.001	< 0.001
常量	-0.651	0.936	0.484	0.487	0.521