基于CHAID法广州市居民首诊医疗单位影响因素分析

目的 了解广州市居民就医首选医疗单位类型，分析影响居民选择医院的影响因素，为政府部门推动分级诊疗提供相关参考意见。方法 分层随机抽样法抽取广州市3个代表市区，每个区随机选取医院和社区卫生服务中心各3个，每个医疗机构随机选取50个门诊病人进行问卷调查，实际有效问卷927份。结果 59.2%的居民选择非基层医院，决策树和多分类Logistic回归分析显示，年龄、身体状况、文化程度、医保、月收入水平、是否有慢性病、医务人员水平对居民首诊医疗机构选择有影响，其中居民文化程度和是否注重医务人员水平存在交互作用。医保为商业保险（OR = 4.57,P≤0.05）、自费（OR = 2.50,P≤0.01）的居民倾向于选择非基层医院。结论 鼓励居民基层医疗机构首诊，制定完善的医保政策，加大各级医院医保报销比例差距，引导居民合理分流。

Analysis of influencing factors of first diagnosis institution among outpatients in Guangzhou Based on CHIAD

Objective To investigate the types of first diagnosis institution and analyze the factors influencing the choice, then providing suggestions for government departments to improve the system of tiered medical services. Methods Stratified random sampling was used to investigate three representative districts in Guangzhou, where 3 hospitals and community health service centers were selected, and 50 outpatients were randomly selected from each medical institution. 927 effective questionnaires were obtained. Results 59.2% of the residents chose non-primary hospitals. The decision tree and logistic regression analysis showed that age, physical condition, education level, health insurance, income level, chronic disease, the level of medical staffs have an impact on the choices of first diagnosed medical institutions, and there is interaction between the educational level of residents and the technical level of medical staffs. Commercial insurance (OR=4.57, P=0.05) or uninsured (OR=2.50, P=0.01) residents tend to choose non-primary hospitals. Conclusion First diagnoses to Community Health Centre should be encouraged, and a sound medical insurance policy should be instituted to enlarge reimbursement proportion gap among the diverse rank hospital, so that residents were shunted reasonably.