The Influencing Factors Of Medical Decision-making Delay In Patients With Acute Ischemic Stroke Based On System Dynamics

Objectives1.To understand the current situation of medical decision-making delay in patients with acute ischemic stroke,and explore the key influencing factors of medical decision-making delay in patients with acute ischemic stroke based on the health ecology model.2.Build a system dynamics model for medical decision-making delay in patients with acute ischemic stroke,and dynamically analyze the impact of key factors by changing the parameters of key variables to conduct simulation experiments.MethodsA questionnaire survey was conducted from October 2021 to June 2022 on patients with acute ischemic stroke who were hospitalized in the Department of Neurology of a Class III hospital in Qingdao.The basic demographic information,information related to stroke disease,stroke knowledge level,health literacy,family adaptability and cohesion,social support,environmental policy and other data were included.Descriptive statistical analysis and discrepancy tests were conducted on the data utilizing SPSS,using frequencies and percentages depicting count data,and using chi square test or Fisher’s exact test for comparative analysis;The normal distribution measures were expressed by means ± standard deviations,and compared by t-test;The non-normal distribution measures were represented by the median and quartile intervals,and compared by two independent sample rank sum tests.Logistic regression was used to analyze the influencing factors.The system dynamics simulation model is built using the Anylogic simulation platform.Based on the cross-sectional survey data,the simulation of the process of medical decision-making delay is carried out.The validity of the model is checked by calculating the relative error and the mean square percentage error.The simulation experiment is carried out by changing the parameters of key factors to dynamically verify the impact of key factors on the medical decision-making delay.Results1.A total of 480 patients with acute ischemic stroke were investigated,of whom61.87% were male patients,and 62.50% were older than 60 years old;2.The median delay time of medical decision-making for patients with acute ischemic stroke was 4 hours,285 patients had medical decision-making delayed,and the rate of delay was 59.38%;3.The score of stroke knowledge of patients with acute ischemic stroke was(22.53±7.72),the score of health literacy was 95(86,101),the score of family adaptability and cohesion was(118.51±12.99),and the score of social support was(37.16±6.14);4.The results of univariate analysis showed that age,number of physical examinations,whether the stroke symptoms first occurred or recurred,whether there was a family history of stroke,severity of stroke,numbness or weakness of limbs,unstable walking,leaning to one side or falling,whether there was a sudden onset of disease,initial stroke recognition of symptoms,initial severity awareness of symptoms,initial reaction of people around the symptoms,medical insurance coverage,and accessibility of medical services,knowledge publicity,stroke knowledge level,health literacy,family adaptability and cohesion,and social support were related to patients’ delay in medical decision-making,and the difference was statistically significant(P<0.05).5.The results of multivariate logistic regression analysis showed that gender,age,whether it was the first stroke,the initial severe perception of symptoms,the initial response of people around the symptoms,and the level of stroke knowledge,health literacy,family adaptability and cohesion,social support,and the level of medical service accessibility were the independent influencing factors of patients’ delay in medical decision-making(P<0.05).6.The relative error between the simulation model built in this study and the real data is less than 10%,the mean square percentage error is 3%,and the model fits well.The system dynamics simulation experiment verified that the level of stroke knowledge,health literacy,family adaptability and cohesion,social support,and accessibility of medical services are all factors affecting the medical decision-making delay of patients,and their contribution to reducing the number of delayed is social support,family adaptability and cohesion,stroke knowledge level,health literacy,and accessibility of medical services from high to low.Conclusions1.The current situation of medical decision-making delay in patients with acute ischemic stroke is not optimistic and needs further improvement;2.Male patients,patients with the first stroke,aged 60 years or older,who initially perceived the symptoms were not serious,and who were not advised to seek medical treatment in time by others were prone to delay in medical decision-making;3.The higher the level of stroke knowledge,health literacy,family adaptability and cohesion,and social support of patients,the less likely they are to delay in medical decision-making.Improving the accessibility of medical services is conducive to reducing the delay in medical decision-making,and the contribution of key factors to reducing the number of delay in medical decision-making is social support,family adaptability and cohesion,stroke knowledge level,health literacy,and medical service accessibility from high to low.In the future,relevant intervention measures should be formulated to improve stroke knowledge,health literacy,family adaptability and cohesion,social support level and accessibility of social medical services.