摘要
目的:了解疾病诊断相关分组(DRG)试点医院医生临床路径依从意愿及其影响因素,为促进临床路径管理工作的开展,DRG支付方式由试点探索向实际付费过渡提供参考。方法:2020年12月至2021年2月,采用立意抽样方法抽取武汉市4所DRG试点医院的医生进行线上问卷调查,问卷内容包括个人基本信息、基于计划行为理论的3个维度、既往临床路径依从行为以及临床路径依从意愿。不同因素对医生临床路径依从意愿影响的单因素分析采用Kruskal-Wallis检验和Wilcoxon符号秩检验,多因素分析采用有序多分类logistic回归分析。结果:共回收有效问卷335份,其中有205名(61.2%)医生临床路径依从意愿高。多因素分析结果显示,相对重视医生同事对于临床路径的态度(OR=16.44)、理解临床路径相关文件内容(OR=14.91)、认同信息系统与临床路径适配好(OR=12.54)、认同临床路径相关学习资源充足(OR=9.42)、认同临床路径能够控制医疗费用(OR=7.83)、近6个月所负责患者的入组率高(OR=5.77)医生的临床路径依从意愿相对更高(P<0.05);而相对重视护理人员对于临床路径的态度(OR=0.11)、近6个月所负责患者的入组完成率高(OR=0.09)、医方原因引发的变异率高(OR=0.00)医生的临床路径依从意愿相对更低(P<0.05)。结论:DRG试点医院多数医生的临床路径依从意愿高,影响医生临床路径依从意愿的主要因素包括既往相关工作经历、周围同事的态度以及支持资源。可通过加快DRG付费工作进程、实行临床路径弹性管理模式、增强医生参与感、保证充足的支持资源,提升DRG试点医院医生临床路径依从意愿。
Objective To study the influencing factors of doctors′compliance intention towards clinical pathways at diagnosis-related groups(DRG)pilot hospitals,as a reference in advancing the development of critical pathways management and the transition of DRG payment methods from pilot exploration to actual payment.Methods With purposive sampling method,an online questionnaire survey was conducted on doctors at 4 tertiary hospitals involved in the DRG pilot in Wuhan from December 2020 to February 2021.The questionnaire covered doctors′basic personal information,identification degree of three dimensions based on the theory of planned behavior,as well as their past compliance behavior and compliance willingness of clinical pathways.The influence of different factors on doctors′clinical path compliance intention was analyzed by Kruskal-Wallis test and Wilcoxon signed-rank test,and the ordered multi-class logistic regression analysis was used in multivariate analysis.Results 335 valid questionnaires were obtained,of which 205(61.2%)doctors had high willingness to follow clinical pathways.Such factors as degree of attention to peer doctors′attitudes towards clinical pathways(OR=16.44),sufficient understanding of the documents(OR=14.91),the adaptation between information systems and clinical pathways(OR=12.54),sufficient learning resources(OR=9.42),and high enrollment rate of their patients in charge in the past six months(OR=5.77),could positively affect the doctors′willingness to follow clinical pathways.The high enrollment completion rate of patients cared by doctors in the past six months(OR=0.09)and the high mutation rate caused by medical prescriptions(OR=0.00)negatively affected doctors′compliance intention towards clinical pathway.Conclusions Most doctors at DRG pilot hospitals had high willingness to comply with the clinical pathways.The main factors affecting their willingness to follow the clinical pathway include,previous relevant work experience,the attitude of peer doctors,and support resources.To incr
作者
罗卿思园
周葭蔚
叶亦盛
陈超亿
冯占春
Luo Qingsiyuan;Zhou Jiawei;Ye Yisheng;Chen Chaoyi;Feng Zhanchun(Tongji Medical College of Huazhong University of Science and Technology,School of Medicine and Health Management,Wuhan 430030,China;Operations Management Department,Zhuhai People′s Hospital(Zhuhai Hospital Affiliated with Jinan University),Zhuhai 519000,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2022年第3期196-201,共6页
Chinese Journal of Hospital Administration
关键词
临床路径
疾病诊断相关分组付费
依从意愿
影响因素
回归分析
Clinical pathways
Diagnosis-related groups payment
Compliance
Influencing factors
Regression analysis
