| Background and significance of research At present,disorder medical treatment has become an important reason for "difficult and expensive medical treatment".For this reason,the state regards classified diagnosis and treatment as the top priority of current medical reform,and regards medical community as an important starting point to realize classified diagnosis and treatment at county level.The balance of interests is the key to the sustainable development of the medical community,and the convergence of interests cognition is the foundation to realize the balance of interests.Therefore,it is an important topic to understand the differences in interest cognition between different groups and to explore cognitive convergence strategies to promote the sustainable development of medical community.However,the current research focuses on the differences of cognition between groups related to graded diagnosis and treatment in terms of system cognition,while the interest research focuses on the conflict of interest and profit and loss analysis,and lacks the comparison of cognitive differences of all parties in terms of interest demands,etc.Therefore,based on qualitative analysis of key interest groups and their interest demands,through empirical analysis,the research intends to clarify the cognitive differences of interest demands of all relevant interest groups in the medical community and analyze their influencing factors,so as to develop targeted coping strategies,promote the cognitive convergence of all parties and promote the sustainable development of graded diagnosis and treatment of the medical community.Research Ideas and Methods Firstly,the key stakeholders of medical community grading diagnosis and treatment are determined through co-word analysis.Secondly,combined with WHO health system performance evaluation model and ERG theory,qualitative analysis of the interests of key stakeholders,and through qualitative stakeholder interviews and other ways to amend and improve.Thirdly,using empirical survey data,this paper analyzes the differences of key stakeholders' understanding of the interests of all parties and their influencing factors.Finally,according to the influencing factors,the targeted cognitive convergence strategy is put forward.Results1.Analysis of key stakeholders.Co-word analysis found that in the current multi-level diagnosis and treatment stakeholder study,residents or patients,core hospitals(lead agencies,general hospitals)and their staff,member hospitals(primary medical institutions)and their staff were the top three mentioned frequently,accounting for 100%,83.3% and75.0% respectively.According to this,it is determined that the key interest groups of the medical community's hierarchical diagnosis and treatment are the medical side and the affected side,of which the medical side includes the general hospital and its medical personnel,primary medical institutions and their medical personnel,and the affected side refers to residents or patients.2.Contents of the demands of both doctors and patients.Through theoretical analysis and consultation,it is found that the main interests of the medical side are compensation,safety responsibility,doctor-patient relationship,career development and technological upgrading.The main interests of the affected party are safety,timeliness,efficiency,economy and convenience.The conflicts of interest between the two sides focus on who has the right to decide the treatment,the safety of diagnosis and treatment or the first two aspects of medical expenses.3.Cognition and difference between doctors and patients on doctors' interests demands.The top three medical self-evaluation demands were income,business volume and personal career development,accounting for30.5%,24.2% and 16.8% respectively.The patients believed that the top three medical claims were income,business volume and security risks,accounting for 59.8%,19.6% and 8.0% respectively.The analysis found that: from the perspective of gender,female medical personnel paid less attention to business volume and career development demands than male medical personnel(p<0.05);The demands for income and safety are higher than that of male medical staff(p<0.05).From the unit level,the lower the level,the higher the medical institutions pay attention to income and business volume(p<0.05).Medical staff working less than five years pay more attention to income and business volume than medical staff working more than five years.Medical staff who have worked for more than 10 years pay more attention to relationship,safety and career development than medical staff who have worked for less than 10 years.From the analysis of professional titles,medical staff below junior professional titles pay more attention to their income.Judging from the nature of work,doctor Yamatonokusushi has higher personal career development than nurse.From the analysis of academic qualifications,there was no significant difference in the attention of medical personnel with different academic qualifications to the above demands(p>0.05).4.Cognition and difference between doctors and patients on patients' interest demands.The top three of patients' self-evaluation demands were medical expenses,efficient medical treatment and safety of medical services,accounting for 50.9%,18.8% and 17.9% respectively.However,doctors believe that the top three demands of patients are medical service safety,efficient medical treatment and medical expenses,accounting for38.9%,25.3% and 21.1% respectively.The influencing factors include referral experience,age,educational background,income,etc.At the same time,the affected party believes that the biggest change brought about by the implementation of the two-way referral system of the medical association is the simple procedures for diagnosis and treatment activities,while the medical party believes that the biggest change is the continuity of medical services.The analysis shows that from the gender perspective,both male and female patients pay more attention to the safety,effectiveness,accessibility,continuity,dignity and confidentiality of medical care(p<0.05).The demands for safety,confidentiality,autonomy and selectivity of young and middle-aged patients are significantly different from those of older patients(p<0.05).From a professional point of view,the staff of enterprises and institutions pay high attention to all aspects of demands.From the analysis of marital status,there was no significant difference in the attention of different marital status to the above demands(p>0.05).From the analysis of educational background,people with higher educational background pay more attention to dignity and confidentiality,autonomy and selectivity than people with lower educational background,and people with lower educational background pay more attention to accessibility.From the point of personal monthly income,the high-income and middle-income groups pay more attention to the above demands,the low-income groups pay more attention to the effectiveness and accessibility,and the other aspects pay less attention(p<0.05).Conclusions The common demands of doctors and patients are economic demand,safety demand and relationship demand.Balancing these needs of doctors and patients will help the smooth implementation of two-way referral.Residents/patients have a low awareness of graded diagnosis and treatment,and relevant publicity and education activities need to be further strengthened.The successful implementation of graded diagnosis and treatment requires the joint efforts of the government,medical institutions,medical personnel and patients,and puts forward coordinated countermeasures to promote cognitive convergence as much as possible. |
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