Study On Patterns And Supervision Mechanism Of Two-way Referral Between Urban Hospitals And Community Health Service Institutions

Objective :The study is based on the literature research , comparison of two-way referral patterns, choose two representative cities,in-depth study on the status quo of supervision .Take hypertension clinical pathway of two-way referral as an example, to explore the factors which impact supervision. Establish supervision and management mechanism of two-way referral according to China's actual situation. Defining and monitoring the main department,content and means and the incentive measures of supervision, in order to promote scientific and systematic management of two-way referral, to keep two-way referral between hospitals and community health service institution running well ,to promote patients use medical resources rational and effective .Methods:1. Literature researchReading professional books and magazines, papers and online information about Responsibilities of government, medical and health services, community health services ,and different types of documents about community health services and two-way referral.2. Local InvestigationMaking research in the hospital and community health service institutions in Nanjing, Wuxi, Qiaokou District, Qingshan District in Wuhan. Bao'an District,Futian District in Shenzhen, ect, about pattern and supervision of the status quo of two-way referral; Systematic sampling method used, Having interviews with 109 staff in the City Community Health Service institution.in Shenzhen and Wuhan, to collect data on 144 medical patients and community resident by questionnaire survey. Data were entried by Epidata and statistical analyzed by spss12.0.3. Key insider interviewInterviews with 54 managers, medical staff with regard to the status quo of two-way referral monitoring, problems of the supervision. Including a total of 12 people in Hedong District in Tianjin( one in charge of the Deputy Secretary for Health, a division of labor, director of the office project, pilot hospitals and community health service managers),32 people in Baoan District or Futian District in Shenzhen (Health Department staff, the hospital vice president in charge of community health service institution, Medical Services Director, Director of the Center for Community Health Services ) .10 people in Wuhan(Hospital leadership and the leadership of community health services)4. The special group discussionTo discuss on the supervision mechanism of two-way referral about the difficulties and problems of the subject and the object,the content and means four times in Wuhan , Shenzhen, Xiamen and Tianjin. At least invited 8 to10 experts each time.5. Statistical AnalysisDescriptive of supervision status, explore the impact of supervision factors by logistic regression analysis. Find patients factors by correspondence analysis method.Results:1. Two-way referral patternsAt present, there are four two-way referral pattern in China : pattern of Government-led , pattern of separating between steering and rowing, pattern of operation and management by hospitals, pattern of interaction between Private community health service institutions and hospitals 2. The status of two-way referralLow proportion of the community clinic, the number of medical clinics accounted for the country's total passenger trips by 6.8%, 7.3% in China's community health service centers (including the station)in 2007 and 2008.patients are easily be transferred to the hospital but difficult transferred to the community. there are person transferred to the hospital to person transferred to community is 7.78times in south long zone of Wuxi, there are person transferred to the hospital to person transferred to community is 6.14times in south long zone of Wuxi Hedong District of Tianjin each month.3. The supervision status of the two-way referralSome cities have taken two-way work into the overall assessment, but the total percentage is not high, which is account for 10% of total in Wuhan and 20% in Shenzhen, ineffective supervision. only 22% of staff believe that effective regulation.4. The impact factors of the two-way referral supervisionThe impact factors of the two-way referral supervision including supervision of the main body of a single, by the influence of human factors (followed by community health service agency staff, higher-level doctors, patients and their families), lack the basis for supervision, with limited means of supervision, incentives and constraints imperfect mechanism.5. To build a supervision mechanism on two-way referralCombined with the management of clinical pathways to build supervision mechanism of two-way referral. The main body of supervision including health departments, health insurance departments, third-party supervision bodies and community-based patients or residents. Supervision indicators of the hospital, including inpatient hospitalization dates and costs, in line with the rate of transfer of community health services, including examination and treatment monitoring indicators, the health management and in line with the rate of turn. Means of supervision the date of control charts, including inpatient, hospital cost control plan, site visits, the residents satisfaction surveys and spot checks of medical records and so on. Improve two-way referral system supervision information. The results of the establishment of supervision feedback mechanisms, including written communication, oral communication, network communication and other forms of communication and the reward and punishment mechanism.Discussions and recommendations :1. To strengthen two-way referral guide policies and regulations. develop the first policy of the community based on the basic medical insurance for urban residents and foreign workers medical insurance services and at the same time establish and improve medical aid to poor residents of the first policy of the community.2. To strengthen the supervisory role of the main regulatory. Training the main sense of supervision of Community residents and patients. Increase two-way referral of publicity by multi-channel, Create a good atmosphere for residents and patients in community to participation.Play the role of monitoring by Third-party. One is supervision of the health insurance sector. According to the Hospital and community health services referral ratio, in line with the rate of referral, referral of diseases, the average length of stay and hospital costs of regulation. The other is to establish a community health service management center, as a set two-way referral management, health surveillance, preventive guidance, training and integration of public health services management services.3. Unimpeded public and third-party channels to supervision. One is the organized expression of channels, the other is the public expression of the channels of public opinion.4. The development of two-way referral clinical pathway management. Including two-way referral clinical pathway to accelerate the development of the patients in the clinics of the variation process.5. The protection of the regulatory examination process. Urban hospitals and community health services assessment as a regulatory system, and engaged in the process of monitoring compliance with those procedures and rules.