中国医疗联盟中的以患者为中心的整合照护如何促进流动人口的医疗保健连续性：尊重的调节作用。
How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect.
机构信息
Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China.
Department of Clinical Medicine, School of Clinical Medicine, Hangzhou Medical College, Hangzhou, China.
出版信息
Front Public Health. 2023 Jan 4;10:1030323. doi: 10.3389/fpubh.2022.1030323. eCollection 2022.
BACKGROUND
Continuity is crucial to the health care of the internal migrant population and urgently needs improvements in China. Chinese government is committed to promoting healthcare continuity by improving the people-centered integrated care (PCIC) model in medical alliances. However, little is known about the driving mechanisms for continuity.
METHODS
We created the questionnaire for this study by processes of a literature research, telephone interviews, two rounds of Delphi consultation. Based on the combination of quota sampling and judgment sampling, we collected 765 valid questionnaires from developed region and developing region in Zhejiang Province. Structural equation models were used to examined whether the attributes of PCIC (namely coordination, comprehensiveness, and accessibility of health care) associated with continuity, and explored the moderated mediating role of respect.
RESULTS
The result of SEM indicated that coordination had direct effect on continuity, and also had mediating effect on continuity via comprehensiveness and accessibility. The hierarchical linear regression analysis showed that the interactive items of coordination and respect had a positive effect on the comprehensiveness (β = 0.132), indicating that respect has positive moderating effect on the relationship between coordination and comprehensiveness. The simple slope test indicated that in the developed region, coordination had a significant effect on comprehensiveness for both high respect group(β = 0.678) and low respect group (β = 0.508). The moderated mediation index was statistically significant in developed areas(β = 0.091), indicating that respect had moderated mediating effect on the relationship between coordination and continuity via comprehensiveness of healthcare in the developed region; however, the moderated mediation effect was not significant in the developing region.
CONCLUSION
Such regional differences of the continuity promoting mechanism deserve the attention of policy-makers. Governments and health authorities should encourage continuity of healthcare for migrants through improving the elements of PCIC-coordination, comprehensiveness and accessibility of healthcare, shaping medical professionalism of indiscriminate respect, and empowering migrants to have more autonomy over selection of services and decisions about their health.
背景
连续性对于流动人口的医疗保健至关重要，中国急需对此加以改善。中国政府致力于通过改进医疗联盟中的以人民为中心的整合医疗（PCIC）模式来促进医疗保健的连续性。然而，对于连续性的驱动机制知之甚少。
方法
我们通过文献研究、电话访谈和两轮德尔菲咨询来创建本研究的问卷。基于配额抽样和判断抽样的结合，我们从浙江省发达地区和欠发达地区共收集了 765 份有效问卷。结构方程模型用于检验 PCIC 的属性（即医疗保健的协调性、全面性和可及性）是否与连续性相关，并探索尊重的调节中介作用。
结果
SEM 的结果表明，协调性对连续性有直接影响，并且通过全面性和可及性对连续性有中介作用。分层线性回归分析表明，协调性和尊重的交互项对全面性有积极影响（β=0.132），表明尊重对协调性与全面性之间的关系有积极的调节作用。简单斜率检验表明，在发达地区，对于尊重程度较高的群体（β=0.678）和尊重程度较低的群体（β=0.508），协调性对全面性都有显著影响。发达地区的调节中介指数具有统计学意义（β=0.091），表明尊重对协调与连续性之间的关系具有调节中介作用，通过医疗保健的全面性；然而，在欠发达地区，这种调节中介效应并不显著。
结论
这种连续性促进机制的区域差异值得政策制定者关注。政府和卫生当局应通过改善 PCIC 的要素（协调性、全面性和可及性）来促进移民的医疗保健连续性，塑造不分青红皂白的尊重的医学专业精神，并赋予移民更多自主权，使其能够自主选择服务和决策自己的健康。
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