基于离散选择实验的公立医院临床医生转诊偏好研究

Research on referral preferences of clinical doctors in public hospitals based on discrete choice experiment

目的调查公立医院临床医生对患者的转诊选择偏好,探讨影响临床医生对患者进行转诊的因素。方法基于离散选择实验就临床医生对患者的转诊选择偏好设计问卷,采用多阶段分层随机抽样方法,以河南省25家公立医院499名临床医生为调查对象,于2023年2—3月进行现场问卷调查。基于Cox比例风险模型参数估计的条件logistic回归分析临床医生对患者的转诊选择偏好及其影响因素,包括患者病情、所在医院对该患者的诊疗能力、患者转诊意愿、手术或主要治疗是否已完成、医院或医保政策对患者转诊支持态度。结果共回收有效问卷439份。医生更倾向于为病情波动的急危重症(β=0.81)、有较大风险以及有一定风险但总体可控(β=0.75,β=0.60)、明确表示转院(β=0.41)、手术或主要治疗未完成(β=0.66)、医院或医保政策支持(β=0.16)的患者进行转诊;不愿意为转诊态度不明确(β=-0.93)、医院或医保政策支持态度不明确(β=-0.23)的患者进行转诊(P<0.05)。结论患者病情、所在医院对患者的诊疗能力、手术或主要治疗是否已完成、患者转诊意愿对医生转诊偏好影响较大,医院或医保政策对患者转诊的支持态度对医生转诊偏好影响较小。

ObjectiveTo investigated the referral preferences of clinical doctors with prescription authority in public hospitals,and to explore the factors influencing clinical doctors′referral decisions.MethodsA questionnaire based on discrete choice experiments was designed to investigate clinical doctors′preferences for patient referral.A multi-stage stratified random sampling method was employed,targeting 499 clinical doctors from 25 public hospitals in Henan Province.The on-site questionnaire survey was conducted between February and March 2023.Conditional logistic regression analysis,based on parameter estimation from Cox proportional hazards models,was used to explore clinical doctors′preferences for patient referral concerning patient condition,hospital capability to manage the patient,patient′s willingness for referral,completion of surgery or major treatment,and hospital or medical insurance policy support for referral preferences.ResultsA total of 439 valid questionnaires were collected.Doctors showed a preference for referring patients with fluctuating acute and critical conditions(β=0.81,P<0.05),patients with high risk or with moderate risk but manageable overall(β=0.75,β=0.60,P<0.05),patients clearly expressing a desire for referral(β=0.41,P<0.05),patients with incomplete surgery or major treatment(β=0.66,P<0.05),and patients supported by hospital or medical insurance policies(β=0.16,P<0.05).Conversely,doctors were reluctant to refer patients with unclear attitudes towards referral(β=-0.93,P<0.05)or unclear hospital or medical insurance policy support(β=-0.23,P<0.05).ConclusionsPatient condition,hospital capability to manage the patient,completion of surgery or major treatment,and patient willingness significantly influence doctors′preferences for patient referral.Hospital support for patient referral has a minor impact on doctors′referral preferences.