上海市某区二级医院2011—2013年跨区转诊病例调查分析

Transregional Patient Referral from Secondary Hospitals in A District of Shanghai from 2011 to 2013

目的 了解上海市某区二级医院2011-2013年跨区转诊病例的特点,为该区医疗决策提供科学依据.方法 从该区医疗急救中心转诊病例数据库中整理出2011-2013年各年上半年（1～6月份）跨区转诊病例,对疾病类型、转入医院进行统计分析.结果 （1）该区二级医院2011-2013年上半年跨区转诊病例分别为1 655例、1 686例、1 491例.（2）转诊病例疾病类型以创伤科、儿科、神经科和心血管科疾病为主,其构成比分别为30.53%、17.40%、17.65%和10.87%.儿科、心血管科转诊病例呈逐年下降趋势,神经科转诊病例呈逐年上升趋势,创伤科转诊病例在2013年上半年呈下降趋势.各年转诊病例的疾病类型分布间差异有统计学意义（P＜0.001）.（3）该区转诊病例主要转入的医院为儿童医院、长征医院、第六人民医院、同济医院、华山医院及瑞金医院.各年转诊病例的转入医院分布间差异有统计学意义（P=0.008）.结论 该地区二级医院转诊病例主要以创伤科、儿科、神经科和心血管科疾病为主,主要的转诊医院为儿童医院、长征医院、第六人民医院和同济医院.应提高该地区二级医院创伤科、儿科、神经科和心血管科的诊治水平,引进优质医疗资源,加强与主要转入医院的合作,建立信息共享平台,以降低该区患者跨区转诊率,减轻患者医疗风险和负担.

Objective To analyze the characteristics of the transregional or cross - district patient referral performed by hospitals of a second tier in a district in Shanghai from 2011 to 2013 with a hope of providing a scientific basis for improvement of the referral system in the future. Methods Data on the cross - district referrals （ including total number of referral, type of the disease requiring referral, and the type and tier of the receiving hospital） made by secondary hospitals in a district in Shanghai in the first six months between 2011 and 2013 were extracted and analyzed. Results In the first six months of 2011, 2012 and 2013 respectively, 1 655, 1 686 and 1 491 transregional referrals were made by secondary hospitals in this studied district. Trauma, pediatric diseases, neurological diseases, and cardiovascular diseases were the major types of diseases that required referral, ac- counting for 30. 53%, 17.40%, 17.65%, and 10. 87% of the total number of referral respectively. The number of pediatric and cardiovascular disease patients referred was declining with time during the three year period and the number of trauma patients referred was decreasing in 2013. In contrast, the number of neurological disease patients requiring referral was gradually increas- ing during the three years analyzed. There were significant differences in the distribution of diseases types and receiving hospitals between years （P 〈0. 001, P =0. 008 ） . Children＇s Hospital, Changzheng Hospital, the Sixth Pcople＇s Hospital, Tongji Hos- pital, Huashan Hospital and Ruijin Hospital were the major receiving hospitals in this district. Conclusion There are significant differences in the total number of referral made, in the disease types requiring referral, and in the distribution of receiving hospi- tals in the past three years in the district analyzed. It is highly anticipated that our findings would provide supplementary informa- tion on which specialty areas need to be strengthened in secondary hospitals in the district analyzed in Shanghai in order to reduce the referral - associated inconvenience and economic burden of the patients.