通讯作者: 杜炎秋, yqdu11@fudan.edu.cn

DOI：10.12201/bmr.202506.00003

Structural Analysis of Influencing Factors for Continuity of Care and Care Coordination: A DEMATEL-AISM Approach

• 摘要：目的 解析整合型医疗卫生服务体系中服务连续性与协调性的关键影响因素及其结构关系,为制定系统性改善策略提供科学依据。方法 以浙江玉环健共体为例,整合DEMATEL(决策实验室法)与AISM(对抗解释结构模型),通过专家问卷与文献分析构建影响因素体系,量化评估17项连续性、14项协调性影响因素的影响度、中心度及层级结构。结果 服务连续性系统中,分工与联动机制(影响度2.516)、支付方式(原因度1.043)为核心驱动因素,构成四级作用网络；协调性系统中,卫生规划(中心度4.452)、医保政策(原因度1.131)为根本致因,形成三阶递阶结构。层级拓扑显示,连续性系统以制度设计-流程衔接-患者感知为传导路径,协调性系统依赖政策牵引-管理协同-技术支撑联动机制。两类系统共享疾病特征(原因度1.650/1.384)为深层诱因,但服务流程(中心度4.680)与管理层意识(中心度4.754)分别成为特性化枢纽节点。结论 服务连续性与协调性改善需实施差异化干预:连续性建设应聚焦支付改革与分工联动机制优化,协调性提升应强化卫生规划引领与医保政策协同。

  关键词： 服务连续性；服务协调性；影响因素；DEMATEL；AISM; ; ; ; 

   

  Abstract: Objective To identify key influencing factors and their structural relationships for continuity of care and care coordination in integrated healthcare systems, providing evidence for systemic improvement strategies. Methods Taking the Yuhuan Health Consortium in Zhejiang Province as an example, this study integrated the Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Adversarial Interpretive Structure Modeling (AISM). An expert questionnaire and literature review were used to construct a factor system, quantifying the influence degree, centrality, and hierarchical structure of 17 continuity and 14 coordination factors. Results In the system of continuity of care, division-of-labor and linkage mechanisms (influence degree: 2.516) and payment methods (causal degree: 1.043) were identified as core drivers, forming a four-level interaction network. For care coordination, health planning (centrality: 4.452) and health insurance policies (causal degree: 1.131) emerged as root causes, establishing a three-tier hierarchical structure. Topological analysis revealed that continuity relies on the institutional design-process articulation-patient perception pathway, while coordination depends on the policy traction-management synergy-technical support linkage mechanism. Both systems shared disease characteristics (causal degree: 1.650/1.384) as underlying drivers, yet service processes (centrality: 4.680) and managerial awareness (centrality: 4.754) served as unique hub nodes. Conclusion Differentiated interventions are required: continuity improvement should prioritize payment reform and division-of-labor mechanisms, while coordination enhancement necessitates strengthened health planning and policy synergy.

  Key words: Continuity of care; Care coordination; Influencing factors; DEMATEL; AISM

  提交时间：2025-06-03

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2025-04-14	bmr.202506.00003V1	下载

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