基于扎根理论和结构方程的分级诊疗绩效评价模型构建研究

Research on the construction of the hierarchical medical system and treatment performance evaluation model based on grounded theory and structural equation

为探究分级诊疗绩效评价模型的结构维度,本研究基于扎根理论,以分级诊疗过程中的政府、医院和患者(居民)三方的具体行为决策建立理论模型;通过579份问卷测试,运用验证性因子分析,路径分析和中介效应分析验证理论模型的合理性。研究表明分级诊疗绩效评价模型大致由分级治理、组织协作、行为动力、就诊选择等4个一级指标、10个二级指标和48个三级指标构成,4项一级指标之间存在显著的促进作用。同时,组织协作对于分级治理和医生行为动力、分级治理和患者就诊选择之间具有完全中介效应,对于行为动力与患者就诊选择之间具有部分中介效应。模型的构建为进一步评价和提升分级诊疗绩效水平提供了重要的理论依据和实践基础。

To explore the classification diagnosis and structure dimensions of the performance evaluation model,this research is based on grounded theory,in a hierarchical medical system and treatment in the process of government,hospital,and patients(residents)of three specific behavioral decision theory models is set up,through the measurement of 579 questionnaires,using confirmatory factor analysis,path analysis and the mediation effect analysis to verify the rationality of the theoretical model.Studies have shown that the performance evaluation model of hierarchical medical system treatment is roughly composed of 4 first-level indicators,10 second-level indicators,and 48 third-level indicators,including hierarchical governance,organizational collaboration,behavioral motivation,and treatment choice.The four first-level indicators have significant promoting effects.At the same time,organizational collaboration has a complete mediating effect between hierarchical governance and doctors'behavioral motivation and a partial mediating effect between hierarchical governance and patients'visit choice.The construction of the model provides an important theoretical and practical basis for further evaluation and improvement of the performance level of hierarchical medical systems and treatment.