【作者】 魏然；

【导师】 张研；

【作者基本信息】 华中科技大学 ， 图书情报（专业学位）， 2024， 硕士

【摘要】 【目的】互联网诊疗作为互联网技术赋能医患交互的重要场景,具有促进优质医疗资源扩容和均衡布局的应用价值。但由于服务设计层面的不完善,互联网诊疗服务至今未能形成“以患者为中心”的高价值服务模式,无法有效满足患者价值需求。基于此,本研究尝试厘清患者视角下互联网诊疗服务的价值基点,识别、梳理“以患者为中心”的互联网诊疗服务的价值创造机理,为互联网诊疗服务的高质量发展提供针对性的策略建议。【方法】首先,在文献分析的基础上,通过半结构化访谈识别患者评估互联网诊疗服务使用价值的核心维度;然后,基于“医——患——技术”三元视角,结合医患体验调查和现场实录,通过广义线性模型识别影响患者服务价值感知的关键条件变量;最后,在关键条件变量识别的基础上,通过模糊集定性比较分析的方式梳理高价值的“以患者为中心”的互联网诊疗服务的形成路径。【结果】(1)健康保障、服务可及、体验价值和替代价值是患者评估互联网诊疗服务使用价值的核心维度;(2)广义线性模型的分析结果表明,在视频问诊服务情境中,疾病适宜度(β=0.060,P<0.001)、患方辅助条件(β=0.048,P=0.014)、在线医生临床执业能力(住院医师哑变量β=-0.128,P=0.003;主治医师哑变量β=-0.206,P<0.001;副主任医师哑变量β=0.004,P=0.960)、医患沟通质量(β=0.043,P=0.013)和信息技术条件(β=0.039,P=0.027)是影响患者服务感知价值水平的关键因素。(3)在此基础上,共生成3条“以患者为中心”的高价值互联网诊疗服务形成路径,分别为组态1(疾病适宜度*患方辅助条件*医患沟通质量*信息技术条件)、组态2(患方辅助条件*医生能力*医患沟通质量*信息技术条件)和组态3(非疾病适宜度*患方辅助条件*医生能力*非医患沟通质量*非信息技术条件),可总结为条件支撑型(组态1和组态2)和能力主导型(组态3)。【结论与建议】互联网诊疗服务患者价值的创造是“医——患——技术”多因素共同作用的过程。从创新生态系统理论视角来看,互联网诊疗服务的价值结果取决于内部生态与外部环境的协同共生程度。基于此,想要推动互联网诊疗服务实践的高质量发展,需要(1)在主体层面完善互联网诊疗组织结构,通过“智慧健康小屋”等模式丰富互联网诊疗服务可利用诊疗资源,并设立高标准的在线医生准入门槛,着重考察在线医生的临床执业和协商交流能力。(2)在内容层面,针对不同场景、不同形式的互联网诊疗服务制定适宜疾病目录,并基于该目录生成患者就医指南。(3)在外部环境层面,通过明确互联网诊疗责任分配机制、完善互联网诊疗筹资支付体制、推动互联网诊疗便民惠民认知以及打造互联网诊疗数字技术基底等手段为其高质量发展保驾护航。更多还原

【Abstract】 [Objective] As an important scenario for Internet technology to enable doctor-patient interaction,Internet-based medical care(IBMC)has the application value of promoting the expansion and balanced layout of high-quality medical resources.However,due to the imperfection of service design,the Internet medical care has not yet formed a "patientcentered" high-value service model,which cannot effectively meet the value needs of patients.Based on this,this study attempts to clarify the value dimensions of IBMC from the perspective of patients,identify and sort out the "patient-centered" value creation mechanism of IBMC,and provide targeted suggestions for the high-quality development of IBMC.[Methods] Firstly,on the basis of literature analysis,the core dimensions of patients’ evaluation of the value of IBMC were identified through semi-structured interviews.Then,based on the "doctor-patient-technology" perspective,combined with the doctor-patient experience survey and on-site records,the generalized linear model was used to identify the key conditional variables that affect the patients’ perceived IBMC value;finally,on the basis of the identification of key conditional variables,the formation path of high-value " patientcentered " IBMC was sorted out by fuzzy-set qualitative comparative analysis.[Results](1)Health security,service accessibility,experience value and substitution value are the core dimensions for patients to evaluate the value of IBMC.(2)The analysis results of the generalized linear models showed that in the context of video consultation service,disease suitability(β = 0.060,P < 0.001),patients’ sub-condition(β = 0.048,P =0.014),doctors’ ability("resident" dummy variable β =-0.128,P = 0.003;"attending doctor" dummy variable β =-0.206,P < 0.001;"deputy chief doctor" dummy variable β = 0.004,P= 0.960),quality of doctor-patient communication(β = 0.043,P = 0.013)and information technology condition(β = 0.039,P = 0.027)were the key factors affecting the patients’ perceived IBMC value.(3)A total of three formation paths of high-value " patient-centered " IMBC were generated through fuzzy-set qualitative comparative analysis,which are configuration 1(disease suitability * patient sub-condition * quality of doctor-patient communication * information technology condition),configuration 2(patient sub-condition* doctors’ ability * quality of doctor-patient communication * information technology condition)and configuration 3(non-disease suitability * patient sub-condition * doctors’ ability * non-quality of doctor-patient communication * non-information technology condition).These conditional configurations can be summarized as condition support type(configuration 1 and configuration 2)and ability leading type(configuration 3).[Conclusion and Suggestion] The creation of patient value in IBMC is a process of "doctor-patient-technology" multi-factor interaction.From the perspective of innovation ecosystem theory,the value of IBMC depends on the degree of synergy between internal ecology and external environment.Based on this,in order to promote the high-quality development of IBMC practice,it is necessary to firstly,at the provider level,improve the organizational structure of IBMC to enrich the available diagnosis and treatment resources of IBMC through models such as "Smart Health Cabin",and establish a high standard online doctor access threshold,focusing on the clinical practice and consultation and exchange ability of online doctors.Secondly,at the content level,a suitable disease directory should be developed for different scenarios and different forms of IBMC,and a patient medical guide should be generated based on the directory.At the environment level,the high-quality development of IBMC is escorted by clarifying the responsibility distribution mechanism of IBMC stakeholders,improving the financing and payment system of IBMC,promoting the cognition of IBMCfor the convenience and benefit of the people,and building the digital technology base of IBMC.更多还原