长沙市卒中住院患者转诊情况的社会网络分析

Social net work analysis of referral of stroke inpatients in Changsha

目的分析长沙市卒中住院患者转诊现状, 探讨转诊网络特征, 为完善卒中分级诊疗提供参考。方法从湖南省卫生健康委员会卫生统计网络直报系统中获取2018年长沙市卒中住院患者的病案首页和医疗机构年报数据, 分析患者在不同医疗机构间的转诊情况, 采用社会网络分析方法分析卒中住院患者转诊网络的密度、K-核和点度中心度。结果共纳入卒中住院患者转诊医疗机构82家, 患者转诊2 859次, 以三级医院之间的转诊居多(1 515次), 且多为卒中联盟内医院转诊(1 123次)。转诊网络密度为0.613, 三级医院处于网络的中心位置, 二级医院的入点处于网络的中心位置, 基层医疗机构位于网络的外围;15-核中的医院19家, 以三级医院居多(14家), 其中12家为湖南省卒中联盟单位。结论三级医院在区域内发挥着重要的辐射带动作用, 二级医院能够接收三级医院转诊的患者, 但下沉到基层医疗机构者较少, 基层医疗机构在转诊网络中的重要性体现不足。卒中联盟的成立一定程度上推动了联盟内医院的协作, 但区域内各级医疗机构的分工协作还有待进一步优化。

Objective To analyze the current status of referral of stroke inpatients and explore the characteristics of the referral network in Changsha,for the reference to improve and promote the hierarchical medical system of stroke.Methods Data of the inpatient medical record of stroke patients and the annual reports of medical institutions in Changsha in 2018 were collected from the health statistics network direct reporting system of Health Commission of Hunan province,for analysis of the referrals of inpatients in different medical institutions.Social network analysis was adopted to analyze the density,centrality and K-core of the referral network of stroke inpatients.Results A total of 82 medical institutions for stroke inpatients were included with 2859 referrals of patients.Most of the referrals were made between tertiary hospitals(1515),especially within hospitals of a stroke alliance(1123).The density of referral network was 0.613.Tertiary hospitals were in the center of the network,the entry points of secondary hospitals were in the center of the network and primary medical institutions were located at peripheral positions.Most of the tertiary hospitals in the 15-core(14,72.68%),12 of them were the units of Hunan Stroke Alliance.Conclusions Tertiary hospitals played an important role in the region,secondary hospitals were able to receive patients referred by tertiary hospitals,but few patients were transferred to primary care institutions;The primary medical institutions failed to play due roles in the referral network.The establishment of stroke alliances could promote the cooperation of hospitals in the alliance,but the division of labor and cooperation among different levels of medical institutions in the region needed to be further optimized.