终末期肾病患者血液透析服务选择偏好研究——基于离散选择实验

Study on the Choice Preference of Hemodialysis Service in Patients with End-stage Renal Disease——Based on Discrete Choice Experiment

目的:研究终末期肾病患者对血液透析服务的选择偏好及影响因素。方法:基于标签式离散选择实验方法设计问卷,通过分层整群抽样方法开展调查,构建混合Logit模型,对408份有效样本进行服务偏好研究。结果:终末期肾病患者对社区血液透析服务具有显著的负向偏好;患者倾向于向上转诊通道流畅有效、医生固定、交通时间20分钟、提供家庭线下随访的血液透析服务,为此分别愿意多支付92.08元、74.52元、47.64元、17.63元;随着服务属性水平累积改变,患者选择社区血液透析服务的概率持续提升。结论:流畅有效的向上转诊通道是患者选择社区透析服务的关键;建议建设紧密型医联体,实现医疗同质化,保障患者安全;改善医患关系连续性,提高延续服务质量。

Objective To study the choice preference and influencing factors of hemodialysis service in patients with end-stage renal disease.Methods A questionnaire was designed based on the label design discrete choice experiment method,and a stratified cluster sampling method was used to conduct the survey.A mixed Logit model was constructed to conduct a service preference study on 408 valid samples.Results The patients with end-stage renal disease had a significant negative choice preference for community hemodialysis services.The patients were willing to pay an additional 92.08 yuan,74.52 yuan,47.64 yuan,and 17.63 yuan for hemodialysis services with smooth and effective upward referral channels,fixed doctors,20 minutes of transportation time,and family offline follow-up.With the cumulative change of service attribute level,the probability of patients choosing community hemodialysis service continues to increase.Conclusion A smooth and effective upward referral channel is the key for patients to choose community dialysis services.It is necessary to build compact medical alliances to achieve medical homogeneity and ensure patient safety,and improve the continuity of doctor-patient relationships to improve the quality of follow-up services.