双向转诊下转难影响因素量化分析

Quantitative Analysis on Influencing Factors of Being Difficult in Two-Way Referral Mode

目的:探讨双向转诊下转难影响因素的权重,为推进双向转诊提供政策建议。方法:查询文献、头脑风暴法获取双向转诊下转难的影响因素,设计权重打分表,德尔菲法咨询专家组和患者组对影响因素的权重判断,Satty权重法计算权重。结果:专家组认为双向转诊下转难影响因素权重分别是机制因素39.5%、患者因素23.0%、基层医院因素16.3%、社会宣传不够11.4%、大医院因素9.7%,细化因素权重前三位为无转诊标准和转诊标准流程16.0%、医疗保险制度不匹配12.0%、患者不信任基层医院11.4%;患者组认为双向转诊下转难影响因素权重分别是患者因素39.0%、基层医院因素28.8%、机制因素14.3%、大医院因素12.3%、社会宣传不够5.6%,细化因素权重前三位为患者不信任基层医院18.5%、基层医院设备差13.8%、患者怕麻烦不愿意下转13.0%。结论:制定转诊标准和流程、并使转诊手续简单化,完善医疗保险制度与双向转诊相匹配、给予下转患者一定的保险激励,建设基层医院、改变基层医院形象,是促进双向转诊的关键。

Objective To investigate the influencing factors＇ weighing on being difficult in two- way referral mode, and provide policy suggestions for promoting the two- way referral mode. Methods The influencing factors were obtained from literature reviewing and brainstorming. By designing the weighing grading form and list, inquiring the judgment of expert teams and patient teams with Delphi method, then the weighing was calculated with Satty weighing grading method. Results In the expert team＇s opinion, weighing was ranked as follows： system factor, 39.5%, patient factor, 23.0%, grass-root hospitals, 16.3%, poor publicity, 11.4%, and comprehensive hospital, 9.7%. And after being relined, the first 3 factors＇ weighing was ranked as no standard and process, unmatched medical insurance system, and mistrusting on grass - root hospitals by patients. As for the patient team, weighing was quite differently ranked as follows： patient factor, 39.0%, grass-root hospitals, 28.8%, system factor, 14.3%, comprehensive hospitals, 12.3%, and poor publicity, 5.6%. And after being refined, the first 3 factors＇ weighing was ranked as mistrusting on grass- root hospitals by patients, unavailable equipments in grass-root hospitals and the patients＇ feeling of inconvenience. Conclusion The key points to promote the two - way referral system are standardizing and simplifying the process of referral, perfecting the matched medical insurance system, providing incentive to patients and remodeling the grass- root hospitals.