Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Public Health. 2021 Apr 29;9:631189. doi: 10.3389/fpubh.2021.631189. eCollection 2021.
China's ability to provide sufficient healthcare for an elderly population with chronic diseases has become a challenge because of poor utilization of different levels of medical institutions. We aimed to explore the characteristics and factors influencing patient choices and the resulting utilization of different levels of public medical institutions among elderly inpatients with chronic diseases. Data were collected from the Information Center of the Health and Family Planning Commission of Pudong New Area in Shanghai from 2013 to 2016. A cross-sectional study using multinomial logistic regression analysis was performed to find the factors influencing use of care. Records of patients were identified from electronic health records from public medical institutions. There were 95,445 elderly inpatients with chronic diseases in public medical institutions, 17.78% in community health centers, 68.44% in secondary hospitals, and 13.78% in tertiary hospitals. Compared with those over 80 years old, the 60-69 age group showed a preference for secondary hospitals (OR = 2.980, < 0.001) and tertiary hospitals (OR = 4.497, < 0.001), a trend also observed in the 70-79 age group (OR = 1.353, < 0.001; OR = 1.673, < 0.001). Compared with those using urban employee basic medical insurance, inpatients using urban resident basic medical insurance were less likely to visit secondary hospitals than community health centers (OR = 0.237, < 0.001) or tertiary hospitals (OR = 0.293, < 0.001). Compared with those inpatients who were married, inpatients who were widowed were less likely to go to secondary hospitals (OR = 0.391, < 0.001) or tertiary hospitals (OR = 0.045, < 0.001) than community health centers. The utilization of different levels of medical institutions by elderly people is not well-suited to the respective functions of these medical institutions. Most care services should be provided by community health centers, but our findings indicate that elderly people are more inclined to seek inpatient care at secondary hospitals and tertiary hospitals with some variation based on the patients' sex, age, medical insurance, expenses, and expected length of stay.
中国为慢性病老年人口提供充足医疗服务的能力面临挑战，这是由于不同级别医疗机构的利用不足所致。我们旨在探讨慢性病老年住院患者选择医疗机构的特征和影响因素，以及由此导致的对不同级别公立医疗机构的利用情况。数据来自 2013 年至 2016 年上海市浦东新区卫生和计划生育委员会信息中心。采用多分类逻辑回归分析进行横断面研究，以寻找影响利用的因素。从公立医疗机构的电子健康记录中识别患者记录。共有 95445 名慢性病老年住院患者在公立医疗机构就诊，其中社区卫生服务中心占 17.78%，二级医院占 68.44%，三级医院占 13.78%。与 80 岁以上的患者相比，60-69 岁年龄组更倾向于选择二级医院（OR=2.980，<0.001）和三级医院（OR=4.497，<0.001），70-79 岁年龄组也存在这种趋势（OR=1.353，<0.001；OR=1.673，<0.001）。与使用城镇职工基本医疗保险的患者相比，使用城镇居民基本医疗保险的患者到二级医院就诊的可能性低于社区卫生服务中心（OR=0.237，<0.001）或三级医院（OR=0.293，<0.001）。与已婚患者相比，丧偶患者到二级医院（OR=0.391，<0.001）或三级医院（OR=0.045，<0.001）就诊的可能性低于社区卫生服务中心。老年人对不同级别医疗机构的利用情况与这些医疗机构的各自功能不匹配。大多数医疗服务应由社区卫生服务中心提供，但我们的研究结果表明，老年人更倾向于在二级医院和三级医院接受住院治疗，根据患者的性别、年龄、医疗保险、费用和预期住院时间，这种情况存在一定差异。
