基于和谐管理理论的居民参与分级诊疗意愿驱动机制研究

Research on the driving mechanism of residents′willingness to participate in tiered medical care based on harmonious management theory

目的基于和谐管理理论,构建与验证居民参与分级诊疗意愿驱动机制理论模型,为推进分级诊疗制度及政府决策提供参考依据。方法基于和谐管理理论及文献资料法,构建居民参与分级诊疗意愿驱动机制理论模型。运用方便抽样法,于2022年4—5月对浙江省24个社区的2067名居民进行问卷调查,对调查结果进行描述性统计分析,运用多层线性回归和结构方程模型分析居民参与分级诊疗意愿的驱动机制。结果居民参与分级诊疗意愿率为69.7%,处于一般水平。回归分析结果显示,政策支持感知(β=0.170,P<0.01)、管理机制感知(β=0.093,P<0.01)、居民认知态度(β=0.102,P<0.01)、居民信任程度(β=0.244,P<0.01)均正向影响居民参与意愿,资源配置感知对居民参与意愿无显著影响(β=0.065,P>0.05)。结构方程模型路径分析结果显示,居民认知态度在"政策支持感知→居民参与意愿"和"管理机制感知→居民参与意愿"影响路径中起部分中介作用,效应值分别为0.030、0.039;居民信任程度在"政策支持感知→居民参与意愿"和"管理机制感知→居民参与意愿"影响路径中起部分中介作用,效应值分别为0.039、0.045;居民信任程度在"资源配置感知→居民参与意愿"影响路径中起完全中介作用,效应值为0.053。结论和谐管理理论可用于解释居民参与分级诊疗意愿形成机制;政府及医疗机构亟待进一步提高居民对分级诊疗的认知水平,着力提升居民信任程度,进一步完善财政投入、医保报销和转诊制度等政策与管理措施。

Objective To construct and validate a theoretical model of residents′willingness to participate in tiered medical care based on harmonious management theory,providing reference for promoting the tiered medical care system and aiding governmental decision-making.Methods Based on the harmonious management theory and literature review,a model capturing residents′propensity to engage in tiered medical care was formulated.Using convenience sampling method,a questionnaire survey was conducted on 2067 residents from 24 communities in Zhejiang province from April to May 2022.Descriptive statistical analysis was conducted on the survey results,and multilevel linear regression and structural equation modeling were used to analyze the driving mechanism of residents′willingness to participate in tiered medical care.Results The willingness rate of residents to participate in tiered medical care was 69.7%,which was at an average level.Regression insights highlighted the positive influence of policy support perception(β=0.170,P<0.01),awareness of management mechanisms(β=0.093,P<0.01),cognitive attitudes(β=0.102,P<0.01),and trust levels(β=0.244,P<0.01)on residents′participation willingness.In contrast,resource allocation perceptions lacked a significant effect(β=0.065,P>0.05).The structural equation model revealed that cognitive attitudes played a mediating role in the"policy system perception→participation willingness"and"management mechanism perception→participation willingness"pathways,with effect sizes of 0.030 and 0.039,respectively.Trust levels also mediated these paths,with effect sizes of 0.039 and 0.045,and entirely mediated the"resource allocation perception→participation willingness"path,registering an effect size of 0.053.Conclusions The harmonious management theory can be used to explain the formation mechanism of residents′willingness to participate in tiered medical care.The government and medical institutions urgently need to further improve residents′awareness of tiered medical care,focus on enhancing residents′trust,and further improve policies and management measures such as financial investment,medical insurance reimbursement,and referral systems.