医联体集团内的双向转诊现状及影响因素分析——基于广东省的调查数据

Status quo and influencing factors of two-way referral within medical association: An analysis based on the survey data of Guangdong Province

目的了解双向转诊现状及原因,探析转诊实际行为的影响因素,为推进双向转诊提供有效参考意见。方法通过问卷调查,了解广东省三地区医联体集团内双向转诊现状及原因,采用卡方检验分析上转和下转实际行为的差异情况,采用偏回归分析和简单对应分析探究对医院(或社区卫生机构)的熟悉情况及与转诊经历的关系,采用多元Logistic回归分析探索转诊实际行为的影响因素。结果医联体集团中的上转比例高于下转比例,政策导向和达到规定转诊指征是上转主要原因,社区卫生机构服务能力有限是医院医生不愿意下转的主要原因,对医院(或社区卫生机构)熟悉程度和月收入是转诊实际行为的影响因素。结论应多管齐下,继续强基层建设、强化转诊意识和简化转诊手续、建立有效沟通以促进彼此熟悉、统一医保报销标准和完善绩效考核指标体系等。

Objective To know about the status quo and causes of two-way referral, and to explore the influencing factors of the actual behavior of referral, so as to provide effective reference for the promotion of two-way referral. Methods A questionnaire survey was conducted to know about the status quo and causes of two-way referral within the medical association group in three regions of Guangdong Province. Chi square test was used to analyze the difference between up transfer and down transfer. Partial regression analysis and simple correspondence analysis were used to explore the familiarity with hospitals(or community health institutions) and the relationship with referral experience. Multiple logistic regression analysis was used to explore the influencing factors of the actual behavior of referral. Results The proportion of up transfer was higher than that of down transfer in the medical association. The main reasons for up transfer were the policy guidance and reaching the specified referral indications. The limited service capacity of community health institutions was the main reason why doctors were unwilling to down transfer. The familiarity with hospitals(or community health institutions) and the monthly income were the influencing factors of the actual behaviors of referral. Conclusions We should work together to solve this problem. We should continue to strengthen the grass-roots construction, strengthen the awareness of referral, simplify referral procedures, establish effective communication to promote mutual familiarity, unify the medical insurance reimbursement standards and improve the performance evaluation index system, so as to provide reference for the government departments to formulate relevant policies.