Study On Influencing Factors Of Doctor’s Clinical Path Adhererance Based On Planned Behavior Theory

[Purpose] The purpose of this study is to use planning behavior theory to construct a doctor ’ s clinical path compliance influencing factor model and put forward research hypotheses;combining the verification results of this theoretical model and the analysis of the implementation of typical sample hospital clinical path,to identify the important impact of doctor ’ s clinical path compliance Factors,on this basis,put forward corresponding improvement strategies.[Methods] This study basically clarified the connotation of clinical path compliance and the main evaluation indicators and evaluation methods through literature research methods;combined with the framework of planned behavior theory to build a research model and proposed related hypotheses.Based on the research results at home and abroad,a framework and factors for influencing factors of doctors’ clinical path compliance were constructed.Conducted in-depth interviews with 37 insiders(including experts in the field of health management,clinical path managers and clinicians),using content analysis to extract the influencing factors of doctors ’clinical path compliance,and combining the results of literature and content analysis to doctors’ clinical path Design and conduct pre-investigation of the compliance influencing factor survey tool,and modify and improve the questionnaire accordingly as a formal survey tool;take a typical sampling method to conduct field surveys of the top three general hospitals in Shandong and Henan provinces,and randomly select each month 6-7 copies of medical records of cesarean section,community-acquired pneumonia(non-severe),and inguinal hernia from January to December 2018.Review the medical records and calculate the compliance rate between the doctor’s order and the route form;collect the sample hospital The data of the clinical pathway access rate,completion rate,variation rate and completion ratio are compared,and the differences are compared;the system regulatory documents related to the clinical path of the sample hospital are collected;the cluster sampling of obstetrics,gastrointestinal surgery and respiratory physicians is carried out.Use the structural equation model toanalyze the questionnaire data,verify the applicability of the theoretical model and verify the relevant research hypotheses one by one;combine the results of the questionnaire analysis,planned behavior theory,and typical cases to discuss the influencing factors of doctors’ clinical path compliance,and Propose corresponding improvement strategies.[Results] 1.The clinical path compliance influencing factors questionnaire finally includes five dimensions of behavior attitude,subjective norms,perceived behavior control,behavior intention,and behavior(adherence),with a total of 27 items.In the field survey,253 questionnaires were effectively recovered,and the effective recovery rate was 84.33%.The reliability and validity of the questionnaires were good.2.Doctors in different hospitals and departments have significant differences in clinical path compliance scores;the age and education of doctors have an impact on the compliance of clinical paths.The higher the degree of doctors,the better the compliance of clinical paths and the lower the number of working years.The higher the doctor’s compliance with the clinical pathway.3.The model fits well under planned behavior theory.Behavioral intention and perceived behavioral control have a positive effect on behavior;behavioral attitude,subjective norms,and perceived behavioral control have a positive effect on behavioral intention.The largest;behavioral attitudes,subjective norms,and perceived behavioral control are related in pairs,and most research hypotheses have been verified.4.The admission rate and completion rate of the clinical pathway of J Hospital are lower than that of H Hospital,and the completion ratio of the pathway is higher than that of H Hospital;The rate of compliance with the clinical route of acquired pneumonia was lower than that of the H hospital;the rate of compliance with the clinical route of the three typical sample diseases was inguinal hernia> cesarean section of the lower uterus>community-acquired pneumonia.[Conclusions] 1.The survey tools designed by this research institute for the influence factors of doctors’ clinical path compliance have good reliability and validity,and can be used in related research.At the same time,this study verifies that the planned behaviortheory has a good explanation and prediction effect on doctors’ clinical path compliance.A research perspective of clinical path compliance.2.Behavioral attitude as the most significant influencing factor affects behavior by influencing behavioral intention;perceptual behavioral control has both direct and indirect effects on clinical path compliance;subjective norms and perceptual behavioral control and behavioral attitudes Influence each other.3.The implementation of the clinical path of the J hospital is better than that of the H hospital,and the clinical path compliance between different diseases is significantly different;the hospital’s role positioning and emphasis on the clinical path,the perfection and effectiveness of the management system,and the design of the clinical path form,The construction level of clinical path information system and other factors have an important impact on the implementation of clinical path compliance.4.From the organizational level,the first step is to guide doctors to form a positive attitude towards the clinical path.Specifically,they should:(1)clarify the role of the clinical path and pay sufficient attention;(2)design a scientific and reasonable clinical path template;(3)establish Complete clinical path information system.The second is to provide corresponding resource support to improve the doctor’s ability to respond to the clinical path,including:(1)organizing relevant publicity and skills training,unblocking information communication and feedback channels;(2)strengthening the cooperation of relevant departments in the hospital.The third is to standardize the system construction of hospitals,including setting scientific and reasonable assessment standards and exploring and improving performance-related incentive mechanisms for clinical pathways.From the policy level,it should:(1)explore and improve the clinical path assessment indicators and methods;(2)strengthen the development and promotion of a unified clinical path information platform;(3)timely issue and update clinical diagnosis and treatment guidelines.