社会资本对居民就医机构选择的影响研究—基于分类树与logistic回归模型相结合的方法
Impact of Social Capital on Residents' Choice of Medical Institutions: A Study Based on Classification Tree Model and Logistic Regression
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摘要:目的 探讨社会资本对居民就医机构选择的影响,为推动分级诊疗提供参考依据。方法 采用Exhaustive CHAID法建立分类树模型对居民就医机构选择的影响因素进行筛选,采用logistic回归模型定量分析影响因素的交互作用效应。结果 分类树模型包括4层,8个终末结点,共筛选出个体社会资本、自评生理健康、文化程度、社区社会资本、慢病患病和自评心理健康6个影响因素。logistic回归分析显示,文化程度〔比值比(odds ratio, OR)=0.660,95%置信区间(confidence interval, CI):0.502~0.869〕,社区社会资本(OR=0.746,95% CI:0.589~0.943)和个体社会资本(OR=0.405,95% CI:0.287~0.572)对居民就医机构选择有影响(P<0.001)。个体社会资本与自评生理健康对居民就医机构选择存在交互作用(OR=1.872,95% CI:1.180~2.969,P<0.05)。结论 应考虑从社会资本因素进行干预,进而促进居民合理利用医疗资源。Abstract:Objective To explore the influence of social capital on the local residents' choice of medical institutions and to provide a reference basis for promoting diagnosis and treatment services available at different tiers.Methods A classification tree model was established using the exhaustive chi-square automatic interaction detection (Exhaustive CHAID) method to screen for factors influencing the residents' choice of medical institutions, and a logistic regression model was used to quantitatively analyze the interaction effect of the influencing factors.Results The classification tree model showed that there were four layers and eight terminal nodes, identifying a total of six influencing factors, including individual social capital, self-reported physical health, education, community social capital, chronic disease prevalence, and self-reported mental health. Logistic regression analysis showed that education (odds ratio OR=0.660, 95% confidence interval CI: 0.502-0.869), community social capital (OR=0.746, 95% CI: 0.589-0.943), and individual social capital (OR=0.405, 95% CI: 0.287-0.572) (P<0.001) had an impact on residents' choice of medical institution. There was an interaction between individual social capital and self-reported physical health on residents' choice of medical institution (OR=1.872, 95% CI: 1.180-2.969, P<0.05).Conclusion Interventions in terms of social capital factors should be considered in order to promote the rational use of medical resources.
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