河南省郸城县县域医共体医生纵向协作影响因素研究

County Medical Communities Doctors'Influencing Factors of Vertical Collaboration in Dancheng County of Henan Province

目的:了解河南省郸城县县域医共体不同层级医生纵向协作的影响因素及作用机制,以期为郸城县及其他地区健全和完善县域医共体医生纵向协作机制提供参考和借鉴。方法:采取分层随机抽样法,选取郸城县3个县域医共体内县乡两级医生作为调查对象。共发放调查问卷300份,回收有效问卷295份。运用结构方程模型探讨分工与协作机制、激励与约束机制、服务规范与标准、价值与文化相容等制度性因素对纵向协作的作用机制。结果:分工与协作机制、价值与文化相容两项与医生纵向协作呈正相关,与纵向协作呈负相关的有激励与约束机制、服务规范与标准。结论:分工与协作机制对纵向协作的正向作用效应最大,价值与文化相容也起到了正向促进作用。郸城县县域医共体需要构建科学有效的激励约束机制与服务规范,多元互动促进不同层级医生纵向协作,提高区域医疗卫生服务水平,从而推动整合型医疗卫生服务体系的建立和完善。

OBJECTIVE To understand the influencing factors and mechanism of vertical collaboration of doctors at different levels in the county medical communities and to provide scientific basis for targeted policy measures in Dancheng,Henan province.METHODS Stratified random sampling method was adopted to select 295 doctors from 3 county medical communities in Dancheng as the research objects to conduct a questionnaire survey.The structural equation model was used to explore the function mechanism of institutional factors such as division of labor and cooperation mechanism,incentive and constraint mechanism,service norms and standards,value and cultural compatibility on vertical collaboration.RESULTS The division of labor and collaboration mechanism,value and cultural compatibility were positively correlated with the vertical collaboration of doctors;incentive and restraint mechanism,service norms and standard were negatively correlated with vertical collaboration.CONCLUSION The division of labor and cooperation mechanism have the greatest positive effect on vertical cooperation,and value and cultural compatibility also plays a positive role in promoting.Dancheng County medical communities needs to build a scientific incentive and constraint mechanism and service standards,promote vertical collaboration of doctors at different levels through multiple ways,improve the continuity and coordination of medical and health services,and promote the improvement of an integrated medical and health service system.