Study Of Two-way Referral Based On Large-scaled Public Hospital In Shanghai

Two-way referral has been carried out in pilot districts, at the same time，residengt’s firstoption in community health system has been popular. During a literature review，we findthe two-way referral does not work well：total referral rate is low， especially in patientsreferred from specialists to general practitioners.Running two-way referral well could achieve a well-organized urban-health-system，provide accessible，convenient，appropriate and low-price health service for patients andmake the medical care more sustainable and coordinated. To achieve the virtuous cycle，coordination between large-scaled hospital and community health service is very important.Large-scaled hospital has a great potential in put two-way referral into effect，andappropriate referral could also promote the public hospital reform for welfare.ObjectivesChoose doctors’ and patients’ cognition and satisfaction on community health andtwo-way referral as the way to find the reasons for poor referral rate. Based on theinfluence factors，in order to realize the two-way referral in Shanghai running normally andgradually achieve patients’ first option in community health system.MethodsBy literature review, specialist interview and questionnaire survey，we want to study (1)community health service in China and Shanghai between years of2006-2012，outpatientand inpatient cost for community health service centers and tertiary hospital between yearsof2009-2012；(2) based on the questionnaire survey of13large-scaled public hospitals，obtain doctors’ and patients’ cognition，use and satisfaction on community and two-wayreferral，also include the willingness to referral，and then do statistical analysis to confirmand find the influence factors on referral service;(3)based on the influence factors，try toput forward some efficient measures to improve the two-way referral.Results1. Enhancing community health service has been popular in recent years, so communityhealth service has developed quickly and has achieved obvious effects, but lack of qualityconstruction and propaganda can not be underestimated. Residents don’t have enoughsatisfaction with community health service and agreement with first option in community,moreover when specialist suggests a referral, there are still36.7%of the patients are notwilling to undertake the referral. 2. Residents with chronic disease and common disease would prefer municipal, districtand specialist hospital,not choose community health service. The main reason forlarge-scaled hospital is for the high medical quality，and choosing community healthservice is for its convenience. The willingness of referral could be influenced by theagreement with first option for community, satisfaction on community health servicewhether can meet their medical demand and burden of medical expense3. Two-way referral is not propaganda widely in Shanghai. Doctors in tertiary hospitalsaren’t familiar with the function of community health service, the process of two-wayreferral and the standard for two-way referral, but most of them have willingness forreferral. The cognition of referral workload could be affected by doctors’ age anddepartments. The willingness of referral could be affected by culture degree and hospitalresources.SuggestionsStrengthen two-way referral propaganda; Optimize community health service system;Perfect two-way referral with a complete set of policies and measures; Enhancelarge-scaled public hospital’s power in the construction of community health service andthe practice of two-way referral.