Mechanism And Impacts Of Continuous Rehospitalization Behavior In Rural Areas

?Objective?To clarify the theoretical framework of continuous hospitalization in rural areas,to understand the current status of continuous hospitalization in rural areas,to explore the changes in the service utilization decision of continuous inpatients,and to explore the relationship between rural residents' high and continuous hospitalization,focusing on cross-disciplinary analysis.The impact of continuous hospitalization experience on the choice of residents' service utilization.?Methods?Through the theoretical deduction,the connotation and boundary of continuous hospitalization were clarified.Combined with the Anderson service utilization model and the characteristics of continuous service,the internal mechanism and influencing factors of continuous hospitalization were determined,and the similarities and differences between hospitalization and re-admission were analyzed.Subsequent empirical research was carried out,using stratified random sampling method to select Hubei Huangpi,Henan Xixian,Henan Yiyang,Chongqing Qianjiang as sample points.And then,through the collection and processing of county –the new rural cooperative medical insurance data,we found and confirmed continuous inpatients,and then conducted retrospective household surveys.A total of 997 consecutive inpatients were surveyed in four counties to understand their experiences and decisions of continuous inpatient services.Factors and the self-control methods were used to compare the behaviors and decision-making factors of the two hospitalizations before and after,and the influencing factors of the changes in the choice of secondary hospitalization were compared by conditional logistic regression.The Qinjiang was used as a sample county to compare the changes in the choice of hospitalized patients with cross-level continuity.The fuzzy exact matching method(CEM)was used to eliminate the imbalance of covariates,and the effect of continuous hospitalization experience on the choice of treatment compared with the general patients.The main analysis software used includes Excel,EpiData 3.1,and SPSS 20.0.?Results?(1)The connotation,process and influencing factors of continuous hospitalization behavior.Continuous hospitalization behavior is time-sensitive(within 30 days),clear path(TTR,TCR,CCR,CTR four flows),diverse forms(inquiries or referrals),and demand-side characteristics;its behavior includes the first inpatient institution The choice and the connection of the two hospitalizations,the re-hospital institution selected three links;in addition to the general factors affecting the utilization of medical services,it is also affected by factors such as the familiar doctor,the satisfaction of the first visit,the degree of cure of the disease,and the way of first discharge.The use of medical services by patients has social effects such as proximity effects,halo effects,and bounded rationality;and the following mechanisms are formed: first,the first hospitalization experience will change and affect the re-hospitalization behavior of patients;second,the continuous hospitalization experience will lead to changes in the choice of re-hospitalization institutions.(2)The level and characteristics of continuous hospitalization.The proportions of CCR,TTR,TCR,and CTR in the sample counties in 2012-2014 were 51.31%,26.35%,13.12%,and 9.22%,respectively;respiratory diseases accounted for 22.06% of all consecutive hospitalized patients;the population of consecutive hospitalized patients The distribution of flow was statistically different in 12 factors including age,education level and marital status(P<0.01).(3)Changes in the costs,utilization,and decision-making factors of consecutive inpatients before and after treatment.There were 68.7% and 91.9% of the patients with changes in the cost of living and hospitalization expenses in the second visit.There were differences in the nine factors of patient selection in the comparison of individual and group(P<0.01).Doctors familiar with TTR and CCR patients increased by 33.6% and 27.9%,and the distance between patients with TCR decreased by 65.1%.The first hospital in the township was not satisfied with the first hospitalization(OR=22.66),and the county level(OR=17.64)was easy to change to the county hospital for rehospitalization.(4)The influence of continuous hospitalization experience on the choice of follow-up institutions for patients.The proportion of patients choosing county-level medical institutions again increased significantly(?2=131.11,P<0.001)after going through cross-level continuous hospitalization behavior.Compared with the general population,the proportion of cross-level consecutive inpatients who chose county hospitals increased significantly(?2 = 17.37,P < 0.001).?Discuss?(1)The level of continuous hospitalization.The proportion of consecutive hospitalizations has increased year by year,and the choice of hospitalization institutions has been increasing;the respiratory system is a high-risk disease of continuous hospitalization.The burden of secondary hospitalization expenses for continuous inpatients is relatively heavy,the interpersonal continuity between doctors and patients is insufficient,and the severity of self-infected diseases is serious.(2)Changes in the behavior of the patients before and after continuous hospitalization will change.It proves the after-effect and near-effects of medical services.The second visit of the patient is related to the first visit,and the weight of the doctors who are familiar with the increase reflects the role of interpersonal continuity in continuous hospitalization,which also confirms the formation of customer loyalty.The near-effects are reflected in the positive impression of the first hospitalization experience,which may strengthen and consolidate the patient's next behavior.Patients have undergone significant changes in the nature of information-carrying and communication behaviors,and are associated with the embarrassment of first-time discharge doctors.(3)Continuous hospitalization the subsequent choice of treatment will change.Cross-level continuous hospitalization may lead to disease delay or cost waste,resulting in lower satisfaction of patients in township hospitals,and the choice of patients in TCR patients continues to be higher after continuous treatment experience.?Conclusion?Continuous hospitalization is an unavoidable service utilization phenomenon in the county service supply system.The current continuous hospitalization is likely to cause delay and repeated treatment,which in turn affects the patient's choice of treatment,resulting in a continuous increase in residents' visits.?Suggestion?Inter-agency service continuity can guarantee the health benefits of continuous inpatients.At the policy level,the software and hardware construction of the first-level clinic should be improved,the awareness and implementation of the grading diagnosis and treatment should be improved,and the interpersonal and information continuity of the two-way referral should be strengthened.The behavior of the supplier should be regulated,and the behavior of the medical staff should be regulated.Strengthen the interpersonal continuity of doctors and patients,establish economic reward and punishment constraints and incentive guarantee mechanisms;medical insurance reform and explore integrated payment.?Innovation & insufficient?The research object is novel.This study starts from the phenomenon of continuous hospitalization,which leads to the phenomenon of objective utilization of services in the county;the research perspective is innovative,and the current county residents continue to get higher,trying to answer the county service supply system and the residents.The primary shortcoming of this study is that 30-day re-admission is the defining criterion for the level of hospitalization in continuous hospitalization.The difference between continuous hospitalization and discontinuous admission cannot be accurately distinguished in the analytical framework.There are less than 1000 consecutive inpatients surveyed.The sample size determines the reliability of the analysis results is limited,and the factors in the analysis of influencing factors are limited.The objective factors for decision-making of continuous inpatients and the decision-making framework may be not enough.It is optimistic that the policy makers can modifiy even make novel the relevant policy to improve the health care service for the rural residents.