基于三级医院背景下的社区老人服务模式及影响因素研究

Research on Community Elderly Service Model and Influencing Factors in the Context of Tertiary Hospitals

目的探索三级医院背景下的社区老人服务模式及其影响因素,找寻针对不同层面的老人最适服务方法,为提高老人生活质量、保障健康水平提供循证依据。方法采取问卷调查及面对面访谈方式对于以三级医院为背景下的社区老人健康服务签约的影响因素进行对应研究,从签约形式(社区签约/门诊签约)、签约对象(慢非病患者/表面健康者)、服务形式(上门服务/医院服务)、老人年龄、文化因素、婚姻状况、收入水平及健康状况等方面进行调查,并进行统计学分析。结果在三级医院背景下,社区老人签约意愿较高,但居家养老依然是社区老人首选养老模式,选择养老机构养老的老人偏少,签约形式以社区签约方式为主[社区签约vs.门诊签约:OR 4.038,95%CI(1.217~9.914)];签约对象以慢非病患者意愿较高[慢非病患者vs.表面健康者:OR 4.071,95%CI(1.087~11.172)];服务形式以上门服务为首选[上门服务vs.医院服务:OR 2.862,95%CI(1.784~8.897)];其中老人文化因素[高中或以下vs.大专及以上:OR 3.955,95%CI(1.508~10.371)]、婚姻状况[已婚vs.单身:OR 2.157,95%CI(1.618~11.837)]、收入水平[月均5000元以上vs.月均小于5000元:OR 3.057,95%CI(2.019~10.237)]及健康因素[健康vs.亚健康:OR 2.852,95%CI(1.808~11.917)];医疗服务水平[一般vs.较高:OR 2.531,95%CI:(1.257~10.865)]是影响社区老人养老签约的主要因素。结论社区老人养老模式依然以居家养老模式为主,影响老人社务签约因素以服务方式、文化水平、收入水平等诸多因素为主,养老趋势有从居家养老向社区签约集约式养老模式转变的趋势,基于三级医院较高医疗服务水平背景下的社区老人对社区养老更趋认同。

Objective To explore the community elderly service model and its influencing factors in the background of tertiary hospitals,to find the most suitable service methods for the elderly at different levels,and to provide evidence-based basis for improving the quality of life and ensuring health of the elderly.Methods Questionnaire surveys and face-to-face interviews were used to study the influencing factors of community elderly health service contracting in the context of tertiary hospitals,and the contract form(community contracting/outpatient contracting),contract objects(chronic non-disease patients/superficially healthy patients),service forms(home service/hospital service),age,cultural factors,marital status,income level and health status of the elderly were investigated,and statistical analysis was carried out.Results In the context of tertiary hospitals,the willingness of the elderly in the community to sign a contract is high,but home care is still the preferred pension mode for the elderly in the community,and there are fewer elderly people who choose pension institutions for the elderly,and the signing form is mainly based on the community signing method[community signing vs.outpatient contracting:OR 4.038,95%CI(1.217-9.914)];The contract subjects were more willing to be patients with chronic non-disease[patients with chronic non-disease patients vs.those with superficially healthy appearance:OR 4.071,95%CI(1.087-11.172)];Service form:Door-to-door service is preferred[home service vs.hospital service:OR 2.862,95%CI(1.784-8.897)];among them,the cultural factors of the elderly[high school or below vs.college and above:OR 3.955,95%CI(1.508-10.371)],marital status[married vs.single:OR 2.157,95%CI(1.618-11.837)],income level[monthly average of more than 5000 yuan vs.monthly average of less than 5000 yuan:OR 3.057,95%CI(2.019-10.237)]and health factors[health vs.sub-health:OR 2.852,95%CI(1.808-11.917)];The level of medical services[general vs.high:OR 2.531,95%CI(1.257-10.865)]is the main factor affecting the signing of the elderly in the community.Conclusions The elderly care model in the community is still dominated by the home care model,and the factors affecting the social affairs contract of the elderly are mainly the service mode,education level,income level and many other factors,and the trend of the elderly has a trend of changing from home care to the intensive pension model of community contracting,and the elderly in the community tend to identify with the community pension under the background of higher medical service level of tertiary hospitals.