A Multi-attribute Decision-making Method For Downward Referral Hospital Selection With Both Doctors And Patients Take Part In Evaluating

Since 2006,China’s new medical reform strategy clearly proposed to establish the system of the first treatment in the community,hospital two-way referral and hierarchical diagnosis and treatment.Explored in this field for decades,China has made many achievements,but also exposed a lot of problems,such as the problem of "easy to upward-referral,hard to downward-referral" occurred in the implementation process of two-way referral.The purpose of the two-way referral system is to liberate the resources of the higher-level medical institutions,make full use of the service functions of the subordinate medical institutions,clear the patient’s medical treatment process,and solve the current status of difficult and high cost to access medical service with limited resources.Now the problem is not solved and even worsening,because of the problem of “easy to upward-referral,hard to downwardreferral”.Therefore,this appearance also got more and more attention from scholars.However,most of the scholars focused on research to exploring the reasons for “hard to downward-referral” use of field research and questionnaires and other qualitative method,and then stressed the improvement of the government system,but the research about establishing a model to promote both doctors and patients to accept the downward-referral is still relatively rare.The development of regional medical information system will inevitably promote the cooperation of the upper and lower hospitals and make it easy for sharing the medical resources and patient information between the higher hospitals and subordinate hospitals,and break the previous barriers in two-way referral.In this paper,we let the stakeholder of the downward referral: doctors and patients,to participate in the referral,and develop a multi-attribute decision-making method for downward referral hospital selection with both doctors and patients take part in evaluating.In this paper,we study multi-attribute decision-making method for downward referral hospital selection with multi-anticipant and different evaluation indexes.The main work is as follows:(1)On the basis of previous studies,analyzed the reasons for the “difficult to downwardreferral”,we refined the problem of hospital referral with doctors and patients involved and put forward the basic theoretical framework of downward referral hospital selection of doctors and patients to participate in the evaluating.There are many literatures on the reasonsfor the problem about “difficult to downward-referral” in two-way referral.To summarize those papers,we proposed that the doctors and patients should participate in the selection of the referral hospitals to improve the satisfaction of patient to downward-referral and solve the doctor worry about subordinate medical institutions can not meet the needs of the state of illness.Then we refined the problem of downward referral hospital selection with both doctors and patients take part in evaluating,analysis of its feasibility and prove that it has a lot of practical background and great theoretical value and practical application value to solve the difficult problem of downward referral.Based on this,the paper gives the research framework of this kind of problem,including the following: First of all,the doctor-patient participation in the evaluation of the downward referral hospital selection issues were described,a decision-making process were developed,and the key points in the process were exacted;Then the paper presents a referral hospital selection problem decision-making method research framework and structure model.The above work provides a theoretical guidance framework for the selection of hospitals in the downward referral with doctors and patients attend.(2)In view of the problem of downward referral hospital selection with both doctors and patients take part in evaluating and their evaluation index set are different,we,firstly,on the basis of summarizing the literature,selected the initial evaluation index system of the doctors and patients,and then use the expert survey method and questionnaire method to obtain the final evaluation index system.(3)For the multi-attribute decision-making method is for downward referral hospital selection,first,use the intuitionistic fuzzy number to evaluate the language.Second,intuitionistic fuzzy soft set is used to deal with the index set of the doctor and the patient.And then,use the maximum entropy theory to obtain the index weight of the new index system.Finally,the IFWA operator is used to assemble the evaluation value and sort to get the best choice.The framework and approach presented in this paper to solve the problem of hospital selection with both doctors and patients take part in evaluating in the downward-referral is a way to optimize the downward referral process,which can improve the rate of downward referral and maximize the needs of stakeholders.In addition,this paper introduces the maximum entropy weighting method into the multi-attribute decision-making problem formulti-participant for the first time,which provides a new idea for multi-attribute decision making.