估计佐治亚州获得产科护理的实际机会:一个离散的选择建模分析
medRxiv : the preprint server for health sciences
|November 24, 2025
概括
产科单位关闭使得产妇护理的机会受到挑战,特别是在农村地区. 一个新的模型揭示了两个不同设施偏好的患者群体,为改善护理分发和获取改善政策提供了信息.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 孕产妇健康 孕产妇健康
- 卫生经济学 卫生经济学
背景情况:
- 美国的产科关闭限制了对孕产妇护理的准入,特别是在农村地区,可能会增加因旅行距离较长或依赖低容量设施而导致的不良结果.
- 了解患者设施选择模式对于旨在支持服务不足地区产科护理和评估干预影响的政策制定者至关重要.
研究的目的:
- 开发和应用一个显露偏好的离散选择建模框架,以根据患者和设施属性估计对产科设施的实现访问.
- 评估模型预测低体积设施和区域接入模式的能力,为更好的患者体积分布提供政策干预信息.
主要方法:
- 利用一个离散选择建模框架,包括一个仅限距离的模型,一个多项逻辑模型和一个潜在类模型,来分析2016-2019年格鲁吉亚出生记录.
- 在预测低体积设施和区域访问方面比较模型性能,根据对距离和设施属性的敏感性确定患者类.
- 纳入患者特征和设施属性 (例如,护理水平,农村,卫生系统附属) 进入模型.
主要成果:
- 隐性类型模型表现出优异的性能,确定了两个不同的患者类:"不太敏感于距离" (34.5%) 和"更敏感于距离" (65.5%).
- 患者选择的分娩设施受到旅行距离,设施护理水平,农村和卫生系统附属性的重大影响.
- 确定了在远程或低容量设施寻求护理的区域模式,突出了健康的社会决定因素对设施选择的影响.
结论:
- 离散选择建模为预测未充分利用的产科设施和了解患者访问模式提供了一个实用的工具.
- 孕产妇护理干预措施必须考虑患者健康的社会决定因素和异质偏好,而不仅仅是地理接近.
- 调查结果可以为政策提供信息,以优化产科护理分配,减轻关闭单位的影响,并改善孕产妇的结果.
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