Yin Shuying, Hu Min, Chen Wen
Department of Health Economics, School of Public Health, Fudan University, Shanghai, People's Republic of China.
Research Department I, Shenzhen Health Development Research and Data Management Center, Shenzhen, People's Republic of China.
Patient Prefer Adherence. 2022 Aug 12;16:2089-2102. doi: 10.2147/PPA.S370805. eCollection 2022.
Outpatients have choices of providers in the hierarchical health service delivery system of China. Understanding how quality perceptions and outpatient experience affect the choice of health facility would help inform decisions about priorities for action aimed at guiding the use of primary care. This study examines how quality perceptions of outpatient service affect the facility level choice in rural China.
Household surveys were conducted in 2011, 2012 and 2015 in Ningxia Hui Autonomous Region, China. We selected 968 respondents as the study sample, who had at least two outpatient visits to the public health facilities during each survey period. Prior quality perceptions of the outpatient service at the village clinics, township centers, and county hospitals were reported on an 8-item Quality Indicator questionnaire. Experienced quality perception from the first outpatient visit was also reported. The outcome of interest was outpatients' facility level choices. We used regression and mediation analysis to explore whether and how outpatient experience at a specific health facility would mediate the relationship between prior quality perceptions and the facility level choice.
Overall, the quality perception was positively and significantly associated with outpatients' staying at the same or lower levels of care (=0.265, =0.007). This effect was fully mediated by experienced quality perception (z=2.985, =0.003). The indirect effect was significant for three particular dimensions, including quality perceptions of the environment (=0.075, =0.025), doctor-patient communication (=0.065, =0.022), and physician ability (=0.062, =0.021).
Outpatient quality perceptions-especially positive perceptions regarding environment, doctor-patient communication, and physician ability-could contribute to minimizing upward referral via improvement in outpatient experience. Policymakers and health care providers may need to therefore optimize outpatient experience as they push to develop a more locally responsive primary care system.
在中国分级医疗服务体系中，门诊患者可以选择医疗服务提供者。了解质量认知和门诊体验如何影响医疗机构的选择，将有助于为旨在引导基层医疗利用的行动重点决策提供信息。本研究考察了中国农村地区门诊服务质量认知如何影响医疗机构层级选择。
于2011年、2012年和2015年在中国宁夏回族自治区开展了家庭调查。我们选取了968名受访者作为研究样本，他们在每个调查期间至少到公共卫生机构进行过两次门诊就诊。通过一份包含8个项目的质量指标问卷报告了对村卫生室、乡镇卫生院和县医院门诊服务的既往质量认知。还报告了首次门诊就诊的体验性质量认知。感兴趣的结果是门诊患者的医疗机构层级选择。我们使用回归和中介分析来探讨特定医疗机构的门诊体验是否以及如何介导既往质量认知与医疗机构层级选择之间的关系。
总体而言，质量认知与门诊患者选择留在相同或更低层级医疗机构呈正相关且具有显著性（β = 0.265，P = 0.007）。这一效应完全由体验性质量认知介导（z = 2.985，P = 0.003）。间接效应在三个特定维度上具有显著性，包括环境质量认知（β = 0.075，P = 0.025）、医患沟通（β = 0.065，P = 0.022）和医生能力（β = 0.062，P = 0.021）。
门诊质量认知——尤其是对环境、医患沟通和医生能力的积极认知——可通过改善门诊体验有助于减少向上转诊。因此，政策制定者和医疗服务提供者在推动建立更具地方响应性的基层医疗体系时，可能需要优化门诊体验。
