Study On Vertical Coordination Of Medical Staff In County Medical Community And Its Influencing Factors

Research objectives:This study analyzed the effect strength of the influencing factors on the vertical cooperative behavior of medical staff at different levels in the county medical community through the study of the vertical cooperative behavior and influencing factors of medical staff at different levels.In order to establish and improve the incentive and restraint mechanism for promoting vertical cooperation and improve the continuity and synergy of medical and health services at the county level,Promote the establishment and improvement of integrated medical and health service system to provide referential policy suggestions.Research methods:1.Literature research.On the basis of the theoretical framework of the previous project "Research on the Theoretical Framework and Index System of the integrated medical and Health Service System",the literature related to the vertical cooperative behavior and influencing factors of the medical staff in the integrated medical and health service system at home and abroad was reviewed.Combined with the specific practice at home and abroad,the analysis framework and questionnaire tool of this study were constructed.2.Questionnaire survey.The EPV method was used to calculate the sample size and stratified convenient sampling method was adopted to conduct a self-filling questionnaire survey in three county medical communities in Dancheng County,Henan Province.A total of 150 medical staff at two levels were randomly selected from each county medical community.A total of 450 questionnaires were distributed,and 420 valid questionnaires were collected,with an effective rate of 93.3%.3.Statistical analysis.SPSS 20.0 software was used to make a descriptive statistical analysis of individual characteristics and vertical cooperative behavior of medical staff in the county medical community of Dancheng County,Henan Province.Kruskal-Wallis H test analysis was used to compare and analyze the basic situation and longitudinal cooperative behavior of medical staff in different subgroups.AMOS 26.0 was used to construct the structural equation model,and the effects of five factors on the status quo of vertical cooperation behavior at the individual level and the institutional level of medical staff in Dancheng County medical community were further analyzed.The test level was α=0.05.Research results:1.To establish an analysis framework of vertical cooperative behavior and influencing factors of medical staff in Dancheng County Medical community.Among them,vertical cooperation behavior covers the dimensions of cooperation frequency,mode,tightness,etc.,and the influencing factors include five factors at the personal level(personal characteristics)and the institutional level(division of labor and cooperation mechanism,incentive and constraint mechanism,service norms and standards,value and culture compatibility)of medical staff.On the basis of this analysis framework,the questionnaire tool is designed,including 31 items.2.Among the 420 samples in this study,229 were county-level medical staff and the remaining 191 were township medical staff.In terms of the frequency of cooperation,the proportion of the two levels of medical staff choosing "≥10 times of cooperation in recent 3 months" and "7-9 times of cooperation in recent 3 months"was the highest.In terms of cooperation forms,the largest number of cooperation forms were 1-2,up to 42.4%;In terms of the number of contact information,the number of medical staff with one or two contact information is the most common way,and the mobile phone number is the most common way.There were significant differences in vertical coordination behaviors among medical staff of different gender,monthly income and position(p<0.05).For example,the number of vertical coordination times and forms of collaboration among male medical staff in the past 3 months was higher than that of female medical staff,and pharmacists and general practitioners had more contact information.3.The structural equation model showed that the division of labor and coordination mechanism(β=0.682,p<0.01),value and culture compatibility(β=0.126,p<0.05)had positive effects on the longitudinal coordination behavior of doctors.The incentive and constraint mechanism(β=-0.120,p<0.01)had a negative effect on the longitudinal cooperation behavior.There was no significant causal effect on the service norms and standards of vertical collaboration of different levels of medical institutions and the personal characteristics of medical personnel(p>0.05).Conclusions and Suggestions:The vertical cooperation level of medical staff at county and township levels in Dancheng County medical community of Henan Province is generally good,reaching a high frequency of cooperation,but there is room for improvement in the diversification of cooperation forms and contact methods.The medical community has established a more scientific and reasonable vertical cooperation division coordination mechanism and value culture system,but the incentive and constraint mechanism of vertical cooperation,service norms and standards need to be further modified and adjusted.In addition,medical staff with different demographic sociological characteristics need to be paid attention to in order to promote the vertical cooperation of medical staff more accurately and fairly.