中国全科医学2018，Vol.21Issue(17)：2101-2105,5.DOI:10.3969/j.issn.1007-9572.2018.00.210
不同级别医疗机构孕产妇就医行为的决策树分析研究
Healthcare-seeking Behavior among Pregnant and Parturient Women from Medical Institutions of Guangzhou:a Decision Tree-based Analysis
摘要
Abstract
Objective To investigate the characteristics of healthcare-seeking behavior among pregnant and parturient women from medical institutions in Guangzhou,providing a reference for guiding such populations to seek healthcare in a scientific way and for the development of hierarchical medical system.Methods We conducted a survey in 675 randomly selected pregnant and parturient women seeking healthcare in a stratified and typical case sample consisting of a primary hospital (Guangzhou Zengcheng District Xintang Hospital,changed to secondary hospital now),a secondary hospital (Zengcheng District Maternal and Child Care Hospital) and a tertiary hospital (Sun Yat-sen Memorial Hospital Sun Yat-sen University) during May to September 2016 with a self-developed questionnaire based on the Andersen healthcare utilization model.A decision tree-based analysis of the survey results was performed to determine the associated factors for pregnant and parturient women seeking healthcare in the chosen hospital.Results The number of participants seeking healthcare in the primary hospital, secondary hospital and tertiary hospital was 207 (30.7%),219 (32.4%),249 (36.9%),respectively.The level of hospital selected for obtaining healthcare differed significantly by age,home-to-hospital distance,waiting time for receiving healthcare,annual household net disposable income per capita,history and number of antenatal examination,number of pregnancy,history of abortion,number of live births,history of premarital checkup,history of pregnancy loss,and level of satisfaction with healthcare(P<0.05).Furthermore,the level of hospital selected for early antenatal registration varied obviously according to medical cost(low or not),quality of care(excellent or not) and home-to-hospital distance(short or not) (P<0.05).Decision tree analysis found that,the accuracy of No.1 decision tree model for predicting the selected primary hospital was much higher compared with predicting the selected secondary hospital (χ2=111.023,P<0.001);Both No.2 and No.3 decision tree models had much higher overall predictive accuracy than No.1 decision tree model(P<0.05). In terms of the causes for choosing the hospital for obtaining healthcare(including early antenatal registration),analysis with No.1 decision tree model demonstrated that those selecting the primary or secondary hospital was mainly due to short waiting time for receiving healthcare and low medical cost,analysis with No.2 decision tree model showed that those choosing the secondary or tertiary hospital was mainly out of annual household net disposable income per capita,number of antenatal examination,number of pregnancy and short home-to-hospital distance,and analysis with No.3 decision tree model presented that those choosing the primary or tertiary hospital was mainly for annual household net disposable income per capita,number of pregnancy,number of live births,and short home-to-hospital distance.Conclusion Policy guidance of the implementation of hierarchical medical system should be strengthened.Pregnant and parturient women without any adverse factors should be guided to seek healthcare in primary or secondary medical institutions.Those choosing tertiary medical institutions just because of high household income should be guided for choosing medical institutions more reasonably.In addition,the importance of undergoing regular prenatal care should be reinforced for pregnant and parturient women seeking healthcare in primary or secondary medical institutions.关键词
孕妇/就医行为/决策树/问卷调查Key words
Pregnant women/Health seeking behavior/Decision trees/Questionnaires分类
医药卫生引用本文复制引用
刘贵浩,杨云滨,耿庆山,薛允莲..不同级别医疗机构孕产妇就医行为的决策树分析研究[J].中国全科医学,2018,21(17):2101-2105,5.基金项目
广东省科技计划项目(2017ZC0276) （2017ZC0276）
广东省医学科研基金项目(B2016090) （B2016090）
