目的 构建急性缺血性脑卒中患者就医决策延迟系统动力学仿真模型，动态分析关键变量对就医决策延迟的影响。方法 采用Anylogic仿真平台构建系统动力学仿真模型，以横断面调查数据为基础，进行就医决策延迟过程仿真模拟，通过计算相对误差和均方百分比误差校核检验模型的有效性，改变关键变量参数进行仿真实验，动态化验证关键变量对就医决策延迟的影响。结果 本研究所构建的仿真模型与真实数据之间的相对误差均＜10%，均方百分比误差值为3%，模型拟合良好。仿真实验结果显示，卒中知识水平、健康素养、家庭亲密度与适应性、社会支持和医疗服务可及性水平均为急性缺血性脑卒中患者就医决策延迟的影响因素，影响程度由高到低依次为社会支持、家庭亲密度与适应性、卒中知识水平、健康素养、医疗服务可及性水平。结论 医疗机构、医护人员应提高卒中患者的知识和健康素养水平，增强家庭亲密度和适应性，加强社会支持以及提高医疗服务可及性水平制定相关的干预措施。

Objective To build a system dynamic simulation model for medical decision-making delay in patients with acute ischemic stroke,and to analyze the influence of key variables on decisional delay.Methods The system dynamics simulation model was built with the AnyLogic simulation platform,based on the cross-sectional survey data and carried out to verify the validity of the simulation model by calculating the relative error and the mean square percent error. Results The deviation of the relative error in the simulation model from that of the real data was less than 10%,and the mean square percentage error was 3%,indicating that the model fit well.The results of the system dynamics simulation experiment showed that knowledge on stroke,health literacy,family adaptability and cohesion,social support,and accessibility of medical services affected the medical decision-making delay of patients, with their effectiveness ranked from high to low as social support,family adaptability and cohesion,stroke knowledge level,health literacy,and accessibility of medical services.Conclusions Medical institutions and medical staff should work out relevant intervention and measures to improve patients’ knowledge on stroke,health literacy,family cohesion and adaptability,social support,and medical service accessibility.

R473.74

山东省自然科学基金(ZR2021MG031)