Research On The Recommendation Of Downward Referral Medical Institutions In Medical Clusters

Since the new medical reform proposed two-way referral and graded diagnosis and treatment system,China has made certain achievements in this field.With the establishment of medical consortia,local medical information system networks have been improved,and members in medical consortia can share medical resources and patient information,which greatly promotes the cooperation between upper and lower level medical institutions,and to a certain extent removes the obstacles in the previous two-way referral.However,in the actual two-way referral,there is still the problem of "difficult downward referral".When there is a need for referral,the higher-level medical institutions often refer patients to the community hospital where they live.The single way of downward referral makes it difficult for the referring hospital to fully meet the actual needs of patients,and the patient’s satisfaction with the referral is low,which ultimately affects the patient’s referral experience and referral quality.The current twoway referral system,especially downward referral,fails to achieve the effect of ensuring patient satisfaction while rationally allocating medical resources.As a result,the problem of difficult downward referrals has received the attention of many domestic and international researchers,but most of the existing studies focus on qualitative analysis,ignoring the fact that the acceptance of the downward referral system can also be improved by improving the subjective feelings of physicians and patients as participants in downward referrals.Therefore,this paper aims to improve the satisfaction of downward referrals,and to recommend medical institutions as an important part of downward referrals,involving the stakeholders of downward referrals,doctors and patients,in the process of downward referrals,and recommending appropriate referral institutions for patients by obtaining the preferences of both doctors and patients.The specific research work is as follows:(1)A downward referral medical institution evaluation index system with different contents of doctor-patient concerns was constructed: Based on the SERVQUAL model,combined with the actual situation of downward referral,and using qualitative and quantitative research methods,we established a comprehensive and multifaceted downward referral medical institution evaluation index system to better reflect the different concerns of doctors and patients in downward referral.The system takes into account both the physician’s professionalism and the patient’s subjective psychological factors,and can reflect more comprehensively the contents that need to be paid attention to when evaluating downward referral medical institutions,and provide an evaluation basis for the recommendation of downward referral medical institutions;(2)Designed a recommendation mechanism for downward referral of medical institutions based on doctor-patient preferences.Based on the construction of the index system,we designed a specific recommendation mechanism by applying the cumulative prospect theory and Q-order orthogonal uncertainty semantic set to the recommendation process,increasing the uncertainty evaluation factors of both doctors and patients,unblocking the fuzzy language expression channel,better reflecting the actual needs of patients,and providing a specific recommendation mechanism for downward referral of medical institutions to higher-level medical institutions.Finally,we confirmed the effectiveness and practicality of the recommendation mechanism through actual cases requiring referrals;(3)Provided suggestions to improve the satisfaction of downward referrals.Based on the results of the above-mentioned study on downward referral,we propose recommendations to improve the empathy,feasibility,economy,reliability,tangibility,and connectivity dimensions of the SERVQUAL model to improve the satisfaction of downward referrals,thus improving the difficult situation of downward referrals.The research in this paper provides a new strategy for downward referral,by improving the recommendation method of referring medical institutions,further optimizes the downward referral process,and ultimately achieves the purpose of improving patients’ satisfaction with downward referral,thus effectively promoting the implementation of the graded diagnosis and treatment policy.