基于结构方程模型的患者使用国家集采种植体意愿的影响因素研究

doi:10.12337/zgkqzzxzz.2025.10.008

中国口腔种植学杂志 ›› 2025, Vol. 30 ›› Issue (5): 481-487.DOI: 10.12337/zgkqzzxzz.2025.10.008

基于结构方程模型的患者使用国家集采种植体意愿的影响因素研究

李悦言¹, 李丽², 矫明秀², 鲍娴静²

¹滨州医学院,烟台 264003;
²滨州医学院附属烟台口腔医院 264003

收稿日期:2025-05-12 出版日期:2025-10-30 发布日期:2025-10-30
通讯作者: 鲍娴静,Email：baoxianjing@126.com,电话：0535-6270121
作者简介:李悦言,公共卫生硕士,研究方向：社会医学与卫生事业管理;鲍娴静,医学硕士,研究方向：社会医学与卫生事业管理
基金资助:
烟台市社会科学规划研究项目（YTSK2024-180）

A study of factors influencing patients' willingness to use national collection of implants based on structural equation modeling

Li Yueyan¹, Li Li², Jiao Mingxiu², Bao Xianjing²

¹Binzhou Medical University, Yantai 264003, Shandong, China;
²The Affiliated Yantai Stomatological Hospital Binzhou Medical University, Yantai 264003, Shandong, China

Received:2025-05-12 Online:2025-10-30 Published:2025-10-30
Contact: Bao Xianjing, Email: baoxianjing@126.com, Tel: 0086-535-6270121
Supported by:
Yantai Municipal Social Science Planning Research Project (YTSK2024-180)

摘要/Abstract

摘要： 目的探讨影响患者选用国家集采种植体的因素,提升患者对集采种植体的使用意愿,减轻患者口腔种植治疗的经济负担。方法采用问卷调查法收集烟台市某三级甲等口腔专科医院696例种植患者（有效问卷回收率90.86%）的临床数据,基于计划行为理论（TPB）构建包含“态度、主观规范、知觉行为规范、感知风险、使用意愿、实际行为”6个维度的结构方程模型（SEM）,分析各维度对患者选用集采种植体意愿的影响路径。结果量表信效度良好（Cronbach’s α=0.774,KMO=0.790,累积方差解释率= 70.52%）,结构方程模型拟合度良好（CMIN/DF=3.414,RMSEA=0.059,IFI=0.939,CFI=0.939,TLI=0.925）。路径分析显示：态度（直接效应=0.15,P<0.05）、主观规范（直接效应=0.80,P<0.05）可直接正向影响使用意愿;使用意愿（直接效应=0.60,P<0.05）、感知风险（直接效应=0.17,P<0.05）可直接影响实际行为;知觉行为规范对使用意愿无显著影响（P>0.05）。主观规范中,“朋友介绍”的条目载荷系数最高（1.88）,对患者决策影响最大。结论推动患者选用国家集采种植体,应当保证集采种植体质量,降低集采种植体不良事件,提升医生对不同种植体的认知度,充分发挥医生的推介作用,加强对集采种植体的宣传。

关键词: 国家集采种植体, 使用意愿, 结构方程模型

Abstract: Objective To explore factors influencing patients’ willingness to choose nationally centralized procurement dental implants, improve their acceptance of such implants, and reduce the economic burden of oral implant treatment. Methods A questionnaire survey was conducted among 696 implant patients treated at a tertiary Class A specialized dental hospital in Yantai City (valid response rate: 90.86%). Based on the theory of planned behavior (TPB), a structural equation model (SEM) was constructed with six dimensions: attitude, subjective norm, perceived behavioral control, perceived risk, willingness to use, and actual behavior. The structural equation model (SEM) was used to analyze the pathways through which these factors influenced patients’ willingness to use implants under the national centralized procurement program. Results The scale demonstrated good reliability and validity (Cronbach’s α=0.774, KMO=0.790, cumulative variance explained=70.52%), and the structural equation model demonstrated good fit (CMIN/DF=3.414, RMSEA=0.059, IFI=0.939, CFI=0.939, TLI=0.925). Path analysis revealed that attitude (direct effect = 0.15, P<0.05) and subjective norm (direct effect = 0.80, P<0.05) had direct positive effects on willingness to use. Willingness to use (direct effect = 0.60, P<0.05) and perceived risk (direct effect = 0.17, P<0.05) directly influence actual behavior; perceived behavioral norms had no significant effect on intention to use (P>0.05). Among subjective norm indicators, Tfriend recommendation” showed the highest factor loading (1.88), exerting the strongest impact on patient decision-making. Conclusion To encourage patients’ adoption of nationally centralized procurement implant systems, it is essential to ensure product quality, minimize adverse events, enhance clinicians’ understanding of different implant systems, strengthen the role of clinician recommendations, and improve publicity and patient education regarding procured implants.

Key words: National centralized procurement implants, Use willingness, Structural equation model

李悦言,李丽,矫明秀,等. 基于结构方程模型的患者使用国家集采种植体意愿的影响因素研究[J]. 中国口腔种植学杂志, 2025, 30(5): 481-487. DOI: 10.12337/zgkqzzxzz.2025.10.008

Li Yueyan, Li Li, Jiao Mingxiu, Bao Xianjing. A study of factors influencing patients' willingness to use national collection of implants based on structural equation modeling[J].Chinese Journal of Oral Implantology, 2025, 30(5): 481-487.DOI: 10.12337/zgkqzzxzz.2025.10.008.

参考文献

[1] 王兴. 第四次全国口腔健康流行病学调查报告[M]. 北京:人民卫生出版社, 2018.
Wang X.Report of the fourth national oral health epidemiological survey[M]. Beijing: People’s Medical Publishing House, 2018.
[2] 刘庆新. 口腔种植牙修复在牙列缺损患者中的应用效果分析[J].中国社区医师,2024,40(18):3. DOI: 10.3969/j.issn.1007-614x.2024.18.013.
Liu QX.Analysis on application effect of dental implant restoration in patients with dentition defect[J]. Chin Community Dr, 2024, 40(18): 3. DOI: 10.3969/j.issn.1007-614x.2024.18.013.
[3] 季媛媛. 多地调低种植牙医疗服务费用“金口银牙”时代终于落幕?[N].21世纪经济报道,2023-02-28(3).DOI:10.28723/n.cnki.nsjbd.2023.000702.
Ji YY. Multiple regions cut dental implant medical service fees—has the era of “golden teeth”finally ended?[N]. 21st Century Business Herald, 2023-02-28(3). DOI: 10.28723/n.cnki.nsjbd.2023.000702.
[4] 国家医疗保障局. 国家医疗保障局关于开展口腔种植医疗服务收费和耗材价格专项治理的通知[EB/OL].(2022-09-08) [2024-09-12]. https://www.nhsa.gov.cn/art/2022/9/8/art_104_9041.html.
National Healthcare Security Administration. Notice on carrying out special governance of dental implant medical service fees and consumable prices [EB/OL].(2022-09-08) [2024-09-12]. https://www.nhsa.gov.cn/art/2022/9/8/art_104_9041.html.
[5] 孙秀艳,史自强,王永战.集采价格落地,“种牙”费用下降明显[N].人民日报,2023-05-19(19). DOI: 10.28655/n.cnki.nrmrb.2023.005180.
Sun XY, Shi ZQ, Wang YZ. Centralized procurement cuts dental implant costs significantly[N]. People's Daily, 2023-05-19(19). DOI: 10.28655/n.cnki.nrmrb.2023.005180.
[6] Schifter DE, Ajzen I.Intention, perceived control, and weight loss: an application of the theory of planned behavior[J]. J Pers Soc Psychol, 1985,49(3):843-851. DOI: 10.1037//0022-3514.49.3.843.
[7] Stein CM, Morris NJ, Hall NB, et al.Structural equation modeling[J]. Methods Mol Biol, 2017,1666:557-580. DOI: 10.1007/978-1-4939-7274-6_28.
[8] Rappaport LM, Amstadter AB, Neale MC.Model fit estimation for multilevel structural equation models[J]. Struct Equ Modeling, 2020,27(2):318-329. DOI: 10.1080/10705511.2019.1620109.
[9] 彭丽娟, 刘维佳, 李升午. 某三级甲等医院医用耗材采购的风险管理[J].医疗装备,2020,33(12):53-55.
Peng LJ, Liu WJ, Li SW.Risk management of medical consumables procurement in a tertiary A-level hospital[J]. Med Equip, 2020, 33(12): 53-55.
[10] 方中坚, 王彩依, 沈晨, 等. 高值医用耗材集采现状、问题及对策[J].卫生经济研究,2023,40(9):23-25,28. DOI: 10.14055/j.cnki.33-1056/f.2023.09.015.
Fang ZJ, Wang CY, Shen C, et al.Current status, problems and countermeasures of centralized procurement of high-value medical consumables[J]. Health Econ Res, 2023,40(9):23-25,28. DOI: 10.14055/j.cnki.33-1056/f.2023.09.015.
[11] 陈健, 谢艳艳, 朱钱桢, 等. 集采背景下公立医院口腔专科耗材管理存在的问题及改进建议[J].医疗装备, 2024,37(13):73-75,79. DOI: 10.3969/j.issn.1002-2376. 2024.13.017.
Chen J, Xie YY, Zhu QZ, et al.Problems and improvement suggestions for consumables management in public-hospital dental departments under centralized procurement[J]. Med Equip, 2024, 37(13): 73-75,79. DOI:10.3969/j.issn.1002-2376.2024.13.017.
[12] 林雨薰, 吴英莎, 王书悦, 等. 影响福州地区居民口腔种植治疗选择的原因调查[J].福建医药杂志, 2023,45(6):140-142. DOI: 10.3969/j.issn. 1002-2600.2023.06.048.
Lin YX, Wu YS, Wang SY, et al.A survey on the factors influencing the choice of dental implant treatment among residents in Fuzhou[J]. Fujian Med J, 2023, 45(6): 140-142. DOI: 10.3969/j.issn.1002-2600.2023.06.048.
[13] 吴雅兰, 李三望, 刘健. 我院门诊患者对国家集中带量采购药品认知情况与使用意愿的问卷调查[J].临床合理用药杂志,2022,15(16):40-43. DOI: 10.15887/j.cnki.13-1389/r.2022.16.012.
Wu YL, Li SW, Liu J.A questionnaire survey on outpatients’ awareness and willingness to use drugs procured through national centralized volume-based procurement in our hospital[J]. Chin J Clin Ration Drug Use, 2022,15(16):40-43. DOI: 10.15887/j.cnki.13-1389/r.2022.16.012.

基于结构方程模型的患者使用国家集采种植体意愿的影响因素研究

A study of factors influencing patients' willingness to use national collection of implants based on structural equation modeling

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 0

编辑推荐

Metrics