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

Corresponding author: DU YAN QIU, yqdu11@fudan.edu.cn

DOI: 10.12201/bmr.202506.00003

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  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

  Submit time: 3 June 2025

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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