基于多元统计学方法的社区医养结合供需匹配差异分析及优化

卓书雄; 王吉; 曹福明; 叶侠栋; 吴嘉琳

doi:10.16766/j.cnki.issn.1674-4152.004256

基于多元统计学方法的社区医养结合供需匹配差异分析及优化

doi: 10.16766/j.cnki.issn.1674-4152.004256

上海市浦东新区南码头社区卫生服务中心全科医学科，上海 200125

基金项目:

上海市浦东新区卫生健康委员会青年科技项目 PW2021B-12

详细信息

通讯作者:
吴嘉琳，E-mail: wjlrosy@163.com

中图分类号: R197.61
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- 文章访问数: 5
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-04
- 网络出版日期: 2026-01-07

Analysis and optimization of supply and demand matching difference of community integrated medical and elderly care based on multivariate statistical method

The Nanmatou Community Health Service Center, Pudong New District, Shanghai 200125, China

摘要

摘要: 目的研究上海市浦东新区社区医养结合服务现况，分析供需不平衡差异及影响因素，并提出优化供需矛盾策略，为医养结合事业发展提供理论参考。方法 2024年7—8月，采用分层抽样的方法，筛选符合纳入及排除标准的全科医生330人，老年人380人为研究对象。运用半结构访谈法自行设计医养结合服务维度的问卷展开调查。采用因子分析和K-均值(K-means)聚类分析法对供需匹配进行分析。结果全科医生回收有效问卷292份，有效回收率为88.48%。老年人回收有效问卷350份，有效回收率为92.11%。对供需服务维度进行因子分析适用性检验，全科医生Kaiser-Meyer-Olkin(KMO)检验统计值为0.937，老年人为0.884，巴特利特(Bartlett)球形检验P < 0.001，表明适合做因子分析。因子分析结果显示，医疗巡诊、转诊服务、心理精神支持服务维度供需匹配差异有统计学意义(P < 0.05)。根据公因子得分，进行K-means聚类分析结果显示，在医养结合供需服务6个维度中，全科医生提供的服务维度差异均有统计学意义(P < 0.05)；老年人对健康教育、健康管理、医疗巡诊、中医药服务、心理精神支持服务维度需求差异有统计学意义(P < 0.05)。结论在社区医养结合服务实践中，供需匹配存在一定程度上的差异，是制约养老事业高质量发展的关键因素。本研究从“宏观-中观-微观”3个层面提出优化建议，以进一步缩小供需差距，实现健康养老发展目标。
- 医养结合 /
- 供需 /
- 因子分析 /
- 聚类分析 /
- 多元统计学方法
Abstract: Objective This study investigates the current situation of community-based integrated medical and elderly care in the Pudong New Area of Shanghai, analyzes the imbalance between service supply and demand and its influencing factors, and proposes strategies to optimize supply-demand alignment, thereby providing a theoretical reference for the development of integrated medical and elderly care systems. Methods From July to August 2024, a total of 330 general practitioners and 380 elderly people who met the inclusion and exclusion criteria were selected as the study subjects. The semi-structured interview method was used to design a questionnaire on the service dimensions of medical care. Factor analysis and K-means clustering analysis were used to analyze the matching between supply and demand. Results A total of 292 valid questionnaires were collected from general practitioners, with an effective recovery rate of 88.48%, and 350 valid questionnaires were collected from the elderly, with an effective recovery rate of 92.11%. The applicability test of factor analysis indicated good suitability for both groups, with Kaiser-Meyer-Olkin (KMO) values of 0.937 for general practitioners and 0.884 for the elderly, and Bartlett' s spherical test showing P < 0.001. The results of factor analysis showed that significant differences in the matching of supply and demand in the dimensions of medical examination, referral service, and psychological/spiritual support service (P < 0.05). According to the common factor score, the results of K-means cluster analysis showed that significant differences among the six dimensions of supply-demand services of integrated medical provided by general practitioners (P < 0.05). Among the elderly, significant differences were observed in the needs of health education, health management, medical inspection, traditional Chinese medicine service, and psychological/spiritual support service (P < 0.05). Conclusion In the practice of community integrated medical and elderly care, a certain degree of mismatch exists between supply and demand, which is a key factor limiting the high-quality development of the elderly care industry. Therefore, this study proposes optimization suggestions at the macro, meso, micro levels to further narrow the gap between supply and demand and promote the goal of achieving healthy aging.
- Integrated medical and elderly care /
- Supply and demand /
- Factor analysis /
- Cluster analysis /
- Multivariate statistical analysis

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表 1 全科医生的公因子总方差解释

Table 1. Interpretation of the total variance explained by common factors for the general practitioners

公因子	初始特征值			旋转平方和载入
公因子	合计	方差(%)	累积(%)	合计	方差(%)	累积(%)
F1	2.541	2.49	63.21	2.677	2.63	59.19
F2	1.961	1.92	67.15	2.370	2.32	63.92
F3	1.568	1.54	70.35	1.910	1.87	68.10
F4	1.383	1.36	71.71	1.877	1.84	69.94
F5	1.207	1.18	74.17	1.760	1.73	73.48
F6	1.149	1.13	75.30	1.409	1.38	74.86
F7	1.038	1.02	76.32	1.349	1.32	76.18
F8	1.018	1.00	77.31	1.151	1.13	77.31

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表 2 老年人的公因子总方差解释

Table 2. Interpretation of the total variance explained by common factors for the older individuals

公因子	初始特征值			旋转平方和载入
公因子	合计	方差(%)	累积(%)	合计	方差(%)	累积(%)
F1	1.943	2.21	51.45	2.911	3.31	48.03
F2	1.722	1.96	55.53	1.908	2.17	53.08
F3	1.430	1.63	58.84	1.716	1.95	57.06
F4	1.372	1.56	60.40	1.635	1.86	58.92
F5	1.252	1.42	63.31	1.526	1.73	62.43
F6	1.142	1.30	64.61	1.466	1.67	64.09
F7	1.109	1.26	65.87	1.355	1.54	65.63
F8	1.050	1.19	67.06	1.244	1.41	67.06

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表 3 全科医生与老年人的供需维度匹配差异情况[人数(%)]

Table 3. Differences in supply-demand dimension matching between general practitioners and older adults [cases(%)]

人员	人数	健康教育	健康管理	医疗巡诊	转诊服务	中医药服务	心理精神支持
全科医生	292	281(96.23)	264(90.41)	259(88.70)	138(47.26)	37(12.67)	113(38.70)
老年人	350	309(88.29)	281(80.29)	210(60.00)	29(8.29)	50(14.29)	31(8.86)
χ²值		0.509	0.097	30.818	105.710	1.263	67.420
P值		0.475	0.756	< 0.001	< 0.001	0.261	< 0.001

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表 4 全科医生和老年人的K-means聚类供需维度差异比较

Table 4. Comparison of K-means-derived supply and demand dimensions between general practitioners and older adults

维度	全科医生(类别)						χ²值	P值	老年人(类别)						χ²值	P值
维度	一	二	三	四	五	六	χ²值	P值	一	二	三	四	五	六	χ²值	P值
健康教育	34	93	2	29	56	34	236.046	< 0.001	69	58	63	58	19	42	14.984	0.010
健康管理	65	93	1	24	55	26	197.712	< 0.001	57	59	60	49	18	38	26.467	< 0.001
医疗巡诊	62	90	0	28	56	23	194.451	< 0.001	35	55	50	27	16	27	55.567	< 0.001
中医药服务	18	8	0	5	2	4	25.322	< 0.001	10	4	3	16	6	11	17.274	0.004
转诊服务	52	41	0	22	6	17	92.720	< 0.001	7	5	2	4	5	6	10.349	0.066
心理精神支持	40	37	0	14	10	12	47.331	< 0.001	3	5	3	7	7	6	19.913	0.001

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