Network analysis of correlation between shared decision-making or preferences and the quality of family doctor contracted services among elderly comorbidity patients
Objective To clarify the relationship between decision-making preference or co-decision and contracted service quality of family doctor in elderly comorbidity patients using network analysis,and provide the reference for advocating the concept of common decision-making and promoting the high-quality development of contract services.Methods From July to September 2023,the patients(＞60 years old)with two or more chronic diseases who were signed up at 12 community health service centers in 4 districts of Wuhan city in Hubei Province,and Guiyang city in Guizhou Province,were selected as the subjects.The investigation was performed with the questionnaire including the Family Doctor Contract Service Quality Evaluation Scale,SDM-Q-9 Shared Decision-Making Scale,and Chinese version of decision making tendency(CPS).The R 4.2.2 software was used to analyze the mixed graphical models(MGM)and directed acyclic graphs(DAG)to explore the partial correlation and causal relationship of joint decision-making on contracted service quality.Results Among the subjects,10.52％of subjects preferred active decision-making,21.87％of subjects preferred collaborative decision-making,and 67.61％of subjects preferred passive decision-making.The Cronbach's α for SDM-Q-9 and the Family Doctor Contract Service Quality Evaluation Scale were 0.927 and 0.852,respectively;overall mean scores were 32.065±6.460 and 95.285±8.739,respectively.Network analysis results indicated that the shared decision-making level was a central variable in the signing up for the service quality networks(strength z-score=1.126,intermediary centrality z-score=2.021,closeness centrality z-score=0.953).The DAG and MGM structures and relationships were largely consistent.Decision preferences of elderly patients with comorbidities(r=0.616)and whether they utilized contract services in the past month(r=0.536)influenced the shared decision-making levels.Shared decision-making level directly impacted the horizontal continuity(r=0.938),longitudinal continuity(r=0.675),comprehensiveness(r=0.962),and technical dimensions(r=0.982)of signing up for contract services.Conclusion High-level joint decision-making can help to improve the quality of contract service for elderly comorbidity patients.The community should take the lead in advocating the concept of"common decision-making"to help the high-quality development of contract services.
Elderly comorbidityDecision preferenceFamily doctorsContract service qualityNetwork analysis
NETL
NSTL
万方数据
