面向老年人的广州市三级医院可达性研究

发布时间：2018-09-08 10:40

【摘要】：随着老龄化进程不断加快,老年人这一特殊人群日益成为各领域关注的重点,其中尤以医疗卫生机构服务为甚。包括医疗设施在内的各类公共服务设施配置的服务半径通常是根据全体居民的出行耗时来决定的,容易导致医疗设施布局超出老年人群的日常活动范围,从而影响了老年人群的就医可达性。基于以上背景,本研究选取广州市作为研究区域,以老年人群体作为研究对象,探究城市就医可达性水平的空间分异。研究首先从需求角度出发,对老年人群进行界定,并结合行政区划分布了解广州市老年人口空间分布特征、老年人口数量变化情况,并通过实际的问卷调查,掌握广州市老年人交通出行方式特征及就医行为偏好;其次从供应角度,对广州市医疗机构空间分布特征、服务能力状况及就医服务质量情况进行了研究;然后从供需结合角度,探究老年人就医需求与医院服务能力之间的匹配情况,结合老年人就医需求特征,通过互联网地图获取老年人就医出行交通方式下的OD通行时间,构建多种交通出行方式下的综合交通可达性量测模型,进一步探究广州市老年人就医时空可达性特征,从而判断医缺区;最后针对老年人就医可达性水平及广州市公共交通网络服务水平,对广州市公共交通网络及医院空间布局优化提出建议。研究结论包括:(1)人口老年化趋势较为明显的区域为中心城区及城市北部地区;基于广州市老年人的问卷调查结果显示,老年人就医目的地主要为高等级且口碑较好的大医院,就医出行方式以公交、地铁为主。(2)对老年人就医偏向的各三级医院服务范围及服务能力、医院服务质量进行分析,中心城区存在部分医院服务域内服务人口较少的现象,服务范围内服务人口较多的医院主要分布于南沙区、城市东部的增城及中心城区;城市就医评价数量空间呈现中心城区聚集的单中心格局,而医院服务质量评价的空间异质性较大。(3)利用综合交通模型计算的可达性结果显示老年人就医可达性水平的区域差异显著,整体上城市中心区就医可达性水平整体较高,城市近郊区大部分地区可达性水平较好,其中番禺区地区可达性水平高于北部花都区等地区;城市远郊区可达性水平相整体处于较低水平,番禺南部及城市南端的南沙区可达性水平较低,城市北端的从化地区街口街道附近存在相对较好的就医可达性区域。(4)本研究利用房屋建筑区面积对医院服务范围及服务承载力指数计算过程进行修正,结果显示利用房屋建筑区面积计算出的各医院服务域结果更为精细,区域差异更小,与实际情况更加贴近;此外,基于老年人群就医特征,改进的可达性模型是一种行之有效的可达性测度方法,为探索不同人群就医时空可达性研究提供了新的视角及思路。
[Abstract]:With the acceleration of the aging process, the elderly as a special population has increasingly become the focus of attention in various fields, especially in the medical and health institutions. The service radius of various types of public service facilities, including medical facilities, is usually determined by the travel time taken by the entire population, which can easily lead to the layout of medical facilities exceeding the daily activities of the elderly. Thus affecting the access to health care of the elderly. Based on the above background, this study selects Guangzhou as the research area, takes the elderly as the research object, and probes into the spatial differentiation of the level of accessibility to medical treatment in the city. First of all, from the perspective of demand, the elderly population is defined, and the spatial distribution characteristics of the elderly population and the changes in the number of the elderly population in Guangzhou are understood in combination with the distribution of administrative divisions, and the actual questionnaire survey is carried out. Secondly, from the perspective of supply, the characteristics of spatial distribution of medical institutions, service capacity and quality of medical care in Guangzhou were studied. Then from the point of view of the combination of supply and demand, this paper probes into the matching situation between the medical needs of the elderly and the hospital service ability, combining with the characteristics of the elderly medical needs, and obtains the OD traffic time under the mode of transportation for the elderly patients seeking medical treatment through the Internet map. A comprehensive traffic accessibility measurement model was constructed under various traffic travel modes to further explore the space-time accessibility characteristics of the elderly in Guangzhou to judge the lack of medical care. Finally, according to the level of medical accessibility of the elderly and the service level of Guangzhou public transportation network, the paper puts forward some suggestions on the optimization of the public transport network and hospital spatial layout in Guangzhou. The main conclusions are as follows: (1) the main areas with obvious population aging trend are the central urban area and the northern part of the city, and the results of the questionnaire survey based on the elderly in Guangzhou show that the medical destination of the elderly is mainly high grade large hospitals with good reputation. The main modes of medical travel are public transportation and subway. (2) the service range and service capacity of the elderly hospitals are analyzed, and the quality of hospital service is analyzed. There is a phenomenon that there is a small number of service population in some hospital service areas in the central urban area. The hospitals with large service population are mainly distributed in Nansha district, Zengcheng city and central city area in the eastern part of the city. But the spatial heterogeneity of hospital service quality evaluation is greater. (3) the results of the comprehensive traffic model show that the regional difference of the medical accessibility level of the elderly is significant, and the overall level of access to medical treatment in the urban center is higher. The level of accessibility in most of the near suburbs of the city is higher than that in the northern Huadu district, and the level of accessibility in the far suburbs of the city is at a relatively low level, and the level of accessibility in Panyu district is higher than that in the northern Huadu district. In the south of Panyu and the southern tip of the city, the level of accessibility in Nansha area is low, In the north of the city, there is a relatively good area of access to medical treatment near the street in Conghua district. (4) this study modifies the service range and service carrying capacity index of the hospital by using the area of the building area. The results showed that the results of the hospital service domain calculated by using the area of the building area were more precise, the regional difference was smaller and closer to the actual situation; in addition, based on the characteristics of the elderly people seeking medical treatment, The improved reachability model is an effective method for measuring reachability, which provides a new perspective and train of thought for exploring the spatio-temporal reachability of different populations.
【学位授予单位】：广州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：C913.6

【参考文献】