社会资本对居民就医机构选择的影响研究——基于分类树与logistic回归模型相结合的方法

Impact of Social Capital on Residents’Choice of Medical Institutions:A Study Based on Classification Tree Model and Logistic Regression

目的探讨社会资本对居民就医机构选择的影响,为推动分级诊疗提供参考依据。方法采用Exhaustive CHAID法建立分类树模型对居民就医机构选择的影响因素进行筛选,采用logistic回归模型定量分析影响因素的交互作用效应。结果分类树模型包括4层,8个终末结点,共筛选出个体社会资本、自评生理健康、文化程度、社区社会资本、慢病患病和自评心理健康6个影响因素。logistic回归分析显示,文化程度[比值比(odds ratio,OR)=0.660,95%置信区间(confidence interval,CI):0.502~0.869],社区社会资本(OR=0.746,95%CI:0.589~0.943)和个体社会资本(OR=0.405,95%CI:0.287~0.572)对居民就医机构选择有影响(P<0.001)。个体社会资本与自评生理健康对居民就医机构选择存在交互作用(OR=1.872,95%CI:1.180~2.969,P<0.05)。结论应考虑从社会资本因素进行干预,进而促进居民合理利用医疗资源。

Objective To explore the influence of social capital on the local residents’choice of medical institutions and to provide a reference basis for promoting diagnosis and treatment services available at different tiers.Methods A classification tree model was established using the exhaustive chi-square automatic interaction detection(Exhaustive CHAID)method to screen for factors influencing the residents’choice of medical institutions,and a logistic regression model was used to quantitatively analyze the interaction effect of the influencing factors.Results The classification tree model showed that there were four layers and eight terminal nodes,identifying a total of six influencing factors,including individual social capital,self-reported physical health,education,community social capital,chronic disease prevalence,and self-reported mental health.Logistic regression analysis showed that education(odds ratio[OR]=0.660,95%confidence interval[CI]:0.502-0.869),community social capital(OR=0.746,95%CI:0.589-0.943),and individual social capital(OR=0.405,95%CI:0.287-0.572)(P<0.001)had an impact on residents’choice of medical institution.There was an interaction between individual social capital and self-reported physical health on residents’choice of medical institution(OR=1.872,95%CI:1.180-2.969,P<0.05).Conclusion Interventions in terms of social capital factors should be considered in order to promote the rational use of medical resources.