Study On The Operating Status And Optimization Of Two-way Referral Between One Medical Conjoined Hospital In Shanxi Province

Objective:The purpose of this study is based on the medical association tertiary hospital doctors,primary hospital doctors,tertiary hospital managers,primary hospital managers,patients with the questionnaire survey,to understand their cognition,operating status,satisfaction and impact assessment of two-way referral.To find out the main problems affecting smooth referral between internal medical institutions,find the root causes of the problems and put forward specific feasible solutions and countermeasures.In order to promote the smooth two-way referral within the Medical Consortium and to provide decision basis for the re integration of regional health resources.Method:The results of this study is mainly on three aspects.1.literature.Collect national,Shanxi and several other provinces of grading clinics,Medical Consortium,two-way referral policy documents,health statistics yearbook of Shanxi province from 2013 to 2014.In Pub Med,Wikipedia,CNKI,Wanfang,"Chinese Journal Full-text Database" collected materials on medical and health service system,medical and health policy research.To do a systematic theoretical study of the above mentioned data.2.on-site investigation.Doctors,hospital administrators and patients in a Medical Association of Shanxi Province were surveyed by questionnaire form about two-way referral cognitive situation,the implementation of two-way referral,two-way referral satisfaction and effect evaluation.3.statistical analysis.Statistical software SPSS17.0 was used to analyze the basic situation of doctors,hospital administrators and patients as well as the cognitive status of two-way referral.Single factor chi square test and multivariateLogistic regression analysis were used to examine the willingness of doctors and the willingness to transfer of patients.Result:the results of this study is mainly on three aspects:1.Study on cognition of two-way referral among doctors in medical conjoined hospital(1)Two way referral rate was low.The two-way referral rate of primary hospital doctors was higher than that of tertiary hospitals.The two-way referral rate of primary hospital doctors was 27.78%,Among them,the upward referral rate was18.61%,and the downward referral rate was 9.17%;The two-way referral rate of doctors in tertiary hospitals was 14.45%,the upward referral rate was 11.12%,and the downward referral rate was 3.33%.The referral rate compared to the results of the chi square test for ?2=67.590,P=0.001.(2)Doctors at primary hospitals had better understanding of two-way referral than tertiary hospital doctors,which were 91.94% and 47.41%,respectively.The Chi square test of the two comparisons is ?2=56.453,P=0.001.Two doctors have different understanding of the main obstacles to the two-way referral process(?2=10.992,P=0.012).Tertiary hospital doctors believe that distrust of the medical level of primary and no unified referral system and standards are the main reasons,Grassroots doctors believe that distrust of the medical level of primary and patients lack of awareness of two-way referral are the main reasons.Through the analysis of the influencing factors of the doctor's referral intention,(?2=5.206,P=0.023)it is clear that a clear referral guide will increase the referral willingness of the three hospital doctors.2.Study on the cognition of two-way referral of administrators in medical conjoined hospital.(1)The awareness rate of two-way referral for hospital administrators is low.The awareness rates of tertiary hospital administrators and primary hospital managers were 58.3% and 67.8%,respectively.The satisfaction of the tertiary hospital managers and the primary hospital managers on the implementation of two-way referral was 54.1% and 67.8%.(2)There are 50% of tertiary hospital managers on the two-way referral is not satisfied with the reasons for the fact that there is no uniform two-way referral standards,there are 54.1% of tertiary hospital managers on the two-way referral is not satisfied with the lack of communication between hospitals.There are 80.6% of the primary hospital managers for referral is not satisfied with the reasons for the lack of communication with the superior hospital,unable to share information.There are 38.7% of the primary hospital managers believe that the lack of uniform referral standards are the main reasons.In the case of lack of communication with the superior hospital,only 35.5% of the primary hospital managers said they would often follow the disease.(3)There are differences between the two types of hospital managers in the question of whether it is necessary to incorporate two-way referral into performance appraisal(?2=7.464,P=0.024).Tertiary hospital managers think it is much more necessary to incorporate two-way referral into performance appraisal.3.Study on the cognition of patients with two-way referral(1)The awareness rate of two-way referral for patients was low(32.4%).Medical institutions for patients with two-way referral propaganda were little.Only 28.7% of patients who had heard of two-way referral from medical staff.(2)The analysis of the influence factors of the patients' referral intention shows,that there is a community hospital or township health centers nearby(?2=7.225,P=0.027),there is a medical care(?2=18.677,P=0.001),with referral experience(?2=12.560,P=0.001)of patients with strong willingness to turn.For patients who do not want to refer to the cause of the survey showed that 60.3% of patients said they do not trust the level of diagnosis and treatment of primary hospitals.Conclusion:The two-way referral service has been carried out among the internal medical institutions in Shanxi Province,different functional orientation of hospitals and primary hospitals has been initially formed.But there are still some problems.Two way referral awareness was low,upward referral is easy to turn down difficult;Two way referral awareness was low;Lack of unified referral standards andstandardized referral system;lack of follow-up services,information can not be shared;The operation of two-way referral system lacks supervision and management mechanism;Patients do not trust the level of diagnosis and treatment of primary hospitals;Patients were not active in two-way referral.According to the research results of the survey,combined with the domestic research foundation,we find the causes of these problems,and put forward some corresponding measures,and discusses the referral criteria.