本文選題：鄉(xiāng)鎮(zhèn)衛(wèi)生院 + 不合理入院��； 參考：《華中科技大學(xué)》2016年碩士論文

【摘要】：[目的]本研究在“明確的非診斷性標(biāo)準(zhǔn)”的指導(dǎo)下,采用“田野研究”方法,對(duì)鄉(xiāng)鎮(zhèn)衛(wèi)生院門(mén)診診療過(guò)程中就診患者及醫(yī)務(wù)人員的行為進(jìn)行深入觀察,了解入院決策的決策主體和決策動(dòng)機(jī),并對(duì)入院治療的患者進(jìn)行跟蹤調(diào)查,從需方的角度進(jìn)一步了解患者做出入院決策的原因、心理動(dòng)機(jī)和決策目標(biāo)。在此基礎(chǔ)上,分析鄉(xiāng)鎮(zhèn)衛(wèi)生院供需雙方不合理入院決策的主要決策人、行為動(dòng)機(jī)和決策機(jī)制。[方法]通過(guò)查閱國(guó)內(nèi)外醫(yī)療服務(wù)供需雙方行為、醫(yī)療服務(wù)不合理提供與利用方面的文獻(xiàn),了解供方診療行為、需方就醫(yī)行為的影響因素,不合理醫(yī)療服務(wù)利用和提供方面的研究進(jìn)展,為本文研究奠定基礎(chǔ);然后運(yùn)用現(xiàn)場(chǎng)調(diào)查方法,主要采用“田野調(diào)查”、問(wèn)卷調(diào)查、關(guān)鍵知情人訪談等方法,了解實(shí)際就診過(guò)程中的入院決策人、決策的合理性、醫(yī)患雙方的行為動(dòng)機(jī)。隨后,通過(guò)SPSS12.0運(yùn)用描述分析及卡方檢驗(yàn)對(duì)調(diào)查數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,并通過(guò)典型案例分析法,剖析典型案例中供需雙方的入院決策行為。[結(jié)果]1.田野調(diào)查A、B地區(qū)共153例住院患者,不合理入院患者56例,不合理入院率36.60%。其中A地區(qū)住院患者86例,不合理入院率34.88%;B地區(qū)住院患者67例,不合理入院率38.80%。A、B地區(qū)不合理入院率沒(méi)有統(tǒng)計(jì)學(xué)差異。2.調(diào)查分析表明鄉(xiāng)鎮(zhèn)衛(wèi)生院入院決策人主要為醫(yī)生,A、B地區(qū)共計(jì)153例住院患者,其中110(71.90%)例醫(yī)生為入院決策人,53例需方為決策人(26例患者為入院決策人,17例家屬為入院決策人)。合理入院決策中醫(yī)生作為決策人占比為77.31%,不合理入院決策中醫(yī)生作為決策人占比62.5%。3.調(diào)查中發(fā)現(xiàn)拒絕入院決策的主體主要為患者,36例拒絕入院患者中醫(yī)生拒絕入院的2例,患者拒絕入院的34例。4.從入院決策合理性分析,?2檢驗(yàn)顯示入院決策人對(duì)入院合理性有影響,供方?jīng)Q策中不合理入院構(gòu)成比(31.48%)低于需方?jīng)Q策中不合理入院構(gòu)成比(48.84%),需方在不合理入院決策中發(fā)揮重要作用。5.患者問(wèn)卷調(diào)查分析表明,患者的自我感覺(jué)疾病嚴(yán)重程度影響入院決策合理性,差別具有顯著性差異(P=0.004),自覺(jué)疾病中度嚴(yán)重的患者不合理入院構(gòu)成比最大,為55.56%,自覺(jué)疾病嚴(yán)重程度嚴(yán)重的患者不合理入院構(gòu)成比僅為15.15%;此外,晚上不住在醫(yī)院的患者不合理入院構(gòu)成比(46.65%)高于晚上住在醫(yī)院的患者不合理入院構(gòu)成比(22.95%),差別具有統(tǒng)計(jì)學(xué)意義。6.田野調(diào)查研究發(fā)現(xiàn),需方角度分析,患者年齡、家庭屬性、是否患有慢性病、就診距離、經(jīng)濟(jì)條件、住院費(fèi)用報(bào)銷等因素對(duì)患者入院決策行為有影響,慢性病、經(jīng)濟(jì)條件好、醫(yī)療費(fèi)用報(bào)銷較高的五保戶、低保戶、優(yōu)撫對(duì)象患者更容易做出不合理入院決策;供方角度分析,醫(yī)生以住院治療療效好及住院費(fèi)用報(bào)銷后經(jīng)濟(jì)劃算誘導(dǎo)患者做出不合理入院決策。[結(jié)論]1.鄉(xiāng)鎮(zhèn)衛(wèi)生院不合理入院決策中,供方防御性治療、誘導(dǎo)需求導(dǎo)致的不合理入院決策與患者主動(dòng)要求入院治療導(dǎo)致的不合理入院決策同時(shí)存在,其中新農(nóng)合醫(yī)療保險(xiǎn)的報(bào)銷方案是供需雙方不合理入院決策的重要影響因素。2.建議:完善供需雙方行為監(jiān)督機(jī)制,減少衛(wèi)生院不合理入院;推進(jìn)分級(jí)診療制度,提高村衛(wèi)生室服務(wù)能力,減少衛(wèi)生院不合理入院;探索基層醫(yī)療機(jī)構(gòu)“醫(yī)養(yǎng)結(jié)合”發(fā)展模式,減少老年人不合理入院;合理規(guī)范供方的診療行為,減少供方主導(dǎo)的不合理入院;合理引導(dǎo)需方的就醫(yī)行為,減少需方主導(dǎo)的不合理入院。
[Abstract]:[Objective] in this study, under the guidance of "clear non diagnostic standard", the "field research" method was used to observe the behavior of the patients and medical staff in the outpatient clinic of the township hospital, to understand the decision-making body and the decision-making motivation of the admission decision, and to follow the investigation of the hospitalized patients, from the demand side. On the basis of this, the main decision-makers, behavior motivation and decision-making mechanism of the irrational admission decision of both supply and demand in township hospitals are analyzed. [Methods] through consulting the behavior of both domestic and foreign medical service supply and demand, the unreasonable provision and utilization of medical service In order to understand the diagnosis and treatment behavior of the supplier, the influencing factors of the demand for medical treatment, the research progress of the use and supply of irrational medical services, this paper lays the foundation for this study. Then, using the field survey method, we mainly use "field survey", questionnaire survey, key lovers interview and other methods to understand the actual treatment process. The hospital decision maker, the reasonableness of the decision and the behavioral motivation of both doctors and patients. Then, the statistical analysis of the survey data is carried out by the SPSS12.0 analysis and the chi square test, and the typical case analysis method is used to analyze the admission decision-making behavior of both the supply and demand in the typical case. [results]1. field survey A, 153 patients in the B area, unreasonable entry. There were 56 cases of hospital patients. The irrational admission rate was 36.60%., of which 86 were hospitalized in the area of A, the irrational admission rate was 34.88%, 67 in the B area, the irrational admission rate was 38.80%.A, the irrational admission rate in the B area was not statistically different from that of the.2. investigation and analysis. It was found that the decision makers in the township hospital were mainly doctors, A, and B area, with 153 hospitalized patients. 110 (71.90%) doctors were hospitalized decision makers, 53 cases were decision makers (26 patients were admission decision makers, 17 family members were hospitalized decision makers). The rational admission decision of traditional Chinese medicine students was 77.31%, and the irrational admission decision of traditional Chinese medicine was the main subject of the decision of refusing admission. In 36 cases, 2 cases of refusing admission by traditional Chinese medicine students, 34 cases of.4. refused admission to hospital, the 2 test showed that the admission decision makers had an impact on admission rationality, and the irrational admission ratio (31.48%) in the supplier decision was lower than the irrational admission ratio (48.84%) in the decision making, and the demand side was unreasonably hospitalized. The.5. patient questionnaire survey showed that the patient's self feeling disease severity affects the rationality of admission decision, the difference has significant difference (P=0.004), the proportion of irrational hospitalized patients with moderate serious illness is the largest, and 55.56%, the patients with serious severity of the disease are unreasonably hospitalized. The ratio was only 15.15%; in addition, the ratio of irrational admission to hospital patients (46.65%) was higher than that in the hospital at night (22.95%), and the difference was statistically significant (22.95%). The difference was statistically significant.6. field investigation, the angle of demand, the age of the patients, the family attributes, the chronic disease, the distance of treatment, the economic conditions, Inpatient expense reimbursement and other factors have an impact on patients' admission decision behavior, chronic diseases, good economic conditions, five insured households with higher reimbursement for medical expenses, low insured households, and patients who are more likely to make unreasonable admission decisions. [Conclusion] in the unreasonable admission decision of]1. township hospital, the unreasonable admission decision of the supplier and the unreasonable admission decision caused by the inducement demand and the unreasonable admission decision caused by the hospitalized treatment of the patient are the same. The reimbursement case of the new rural cooperative medical insurance is an important shadow of the unreasonable admission decision of both the supply and demand parties. .2. suggestion: improve the behavior supervision mechanism of both the supply and demand, reduce the irrational admission of the hospital, promote the system of grading diagnosis and treatment, improve the service ability of the village health room, reduce the irrational admission of the hospital, explore the development mode of the combination of medical care in the basic medical institutions, reduce the irrational admission of the old people, and standardize the diagnosis and treatment behavior of the supplier reasonably and reduce the diagnosis and treatment. It is unreasonable to guide the demand side to seek medical treatment and reduce unreasonable demand of the clients.

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R197.62

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