Menting B, van 't Veer L, Kemp R
Autoriteit Consument & Markt, Directie Zorg, Den Haag.
Contact: B. Menting (
Ned Tijdschr Geneeskd. 2020 Aug 13;164:D4742.
To examine to what extent patients' hospital choices are influenced by travel time, their care history, and their general practitioners' (GP) referral history.
Quantitative study.
We used care claims data from 2015 of patients with breast cancer. We selected the initial care products of the breast cancer patients who had been referred to a hospital by a GP or GP practice. We used conditional logit choice models with 82 hospitals in the choice set to assess whether travel time to the hospital, care history of the patient in the preceding two years, and referral history of the GP were related to the choice of hospital. How often patients opted for a default choice hospital was also determined.
We identified 74,227 breast cancer care products representing the hospital choices of 70,608 unique patients (96% female; mean age 52.7 years) who originated from 4840 different GP practices. Travel time, the patient's care history, and GP referral history were all statistically significantly related to hospital choice. Patients more often visited a hospital where they had been before, with a shorter travel time, or where relatively more patients from the same GP practice went to for breast cancer care. The latter improved the model most, followed by patient's care history and travel time. Twelve percent of patients without previous care, and 7% of patients with a care history, did not opt for a default hospital; relatively often a university hospital or specialized hospital was chosen in these cases.
Next to travel time, the patient's care history and the GP's referral history clearly contribute to the hospital choice of breast cancer patients. A considerable cohort opts to receive care in a hospital that, based on travel time, the patient's care history and GP referral history, would not be the default destination.
探讨患者的就医选择在多大程度上受到出行时间、就医史以及全科医生（GP）转诊史的影响。
定量研究。
我们使用了2015年乳腺癌患者的医疗费用报销数据。我们选取了由全科医生或全科医生诊所转诊至医院的乳腺癌患者的初始医疗服务项目。我们使用了选择集中包含82家医院的条件logit选择模型，以评估前往医院的出行时间、患者前两年的就医史以及全科医生的转诊史是否与医院选择有关。还确定了患者选择默认医院的频率。
我们识别出74227个乳腺癌医疗服务项目，代表了70608名不同患者（96%为女性；平均年龄52.7岁）的医院选择，这些患者来自4840个不同的全科医生诊所。出行时间、患者就医史和全科医生转诊史均与医院选择在统计学上显著相关。患者更常前往他们之前去过的医院，这些医院出行时间较短，或者来自同一全科医生诊所的乳腺癌患者前往就医的人数相对较多。后者对模型的改善最大，其次是患者就医史和出行时间。12%无既往就医史的患者以及7%有就医史的患者未选择默认医院；在这些情况下，相对经常选择的是大学医院或专科医院。
除出行时间外，患者就医史和全科医生转诊史显然对乳腺癌患者的医院选择有影响。相当一部分患者选择在一家基于出行时间、患者就医史和全科医生转诊史并非默认就医目的地的医院接受治疗。
