ABSTRACT
Objective@# To investigate patients' satisfaction rate towards referral in a class A tertiary hospital, so as to provide the evidence for promoting the highly efficient implementation of referral. @*Methods @#The gender, age, type of referral, referral efficiency and referral cost of patients receiving referral services in 2021 were collected through the interconnected intelligent hierarchical diagnosis and treatment collaborative platform of Henan Provincial People's Hospital. Patients' awareness and recognition of the two-way referral system were investigated using questionnaire surveys, and factors affecting patients' satisfaction with referral were identified using a multivariable logistic regression model.@* Results@# A total of 1 268 patients receiving referral services were surveyed, including 576 men (45.43%) and 692 women (54.57%), and the respondents were predominant at ages of 18 years and older (935 cases, 73.74%). There were 535 cases with overdue referral (42.19%) and 1 157 cases with free referrals (91.25%). There were 749 cases that were aware of the two-way referral system (59.07%), and 587 cases recognized the two-way referral system (46.29%). There were 975 patients with a satisfactory attitude towards referral, with a satisfaction rate of 76.89%. There were 1 030 cases (81.23%) that considered fluent communication of referral information, with a 78.54% satisfaction rate towards referral; 569 cases (44.87%) that considered simple referral procedures, with an 81.37% satisfaction rate towards referral, and 797 cases that were satisfied with the services provided by the referred medical staff (62.85%), with a 79.42% satisfaction rate towards referral. Multivariable logistic regression analysis showed that non-overdue referrals (OR=1.846, 95%CI: 1.411-2.414), free referrals (OR=1.815, 95%CI: 1.188-2.773), awareness of the two-way referral system (OR=0.624, 95%CI: 0.472-0.826), recognition of the two-way referral system (OR=1.621, 95%CI: 1.235-2.129) were factors affecting the satisfaction with referral.@*Conclusions@# The satisfaction rate towards referral was 76.89% among the study patients, and the awareness and recognition of the two-way referral system, referral efficiency and convenience are factors affecting the satisfaction with referral.
ABSTRACT
Construction of medical alliances could help structural adjustment of medical resources, promote the shift of medical and health investment to primary level, improve the overall effectiveness of the medical service system, and better meet the health needs of the people. Guangzhou has established a multi-form and multi-level medical alliance system in accordance with local conditions. According to the distribution characteristics of medical resources in the districts under the jurisdiction of Guangzhou, these districts were divided into areas of controlled development, those of stable development and those of encouraged development. Different strategies were taken for various medical alliances. Advantages of traditional Chinese medicine were given full play in community health management and elderly care services, alliance of traditional Chinese medicine specialists was established to provide residents with continuous medical and health services. An appropriate medical insurance payment system was established to promote the implementation of the hierarchical diagnosis and treatment system. However, there were still such problems as unbalanced distribution of medical resources, insufficient leverage role played by medical insurances, and rooms of improvement in the ability of primary medical services.
ABSTRACT
" Two-way referral, and synergy between the tertiary hospitals and primary institutions" is the core measure for promoting hierarchical diagnosis and treatment in the region. The authors introduced the exploration and practice of constructing a two-way referral path in the medical alliance based on telemedicine in West China Second University Hospital of Sichuan University. As of May 2021, the hospital had established a two-way referral path with 52 member hospitals of the medical alliance. By clarifying the functionality and positioning of these institutions, optimizing work processes and IT support, building the mechanism of referral and liaison, and that of appraisal as support, these efforts had achieved progresses in such fields as innovative medical service modes, lean management of referral processes, and promotion of hierarchical diagnosis and treatment system building.
ABSTRACT
Objective@#To understand the referral status and the willingness for downward referral among rural elderlies with hospital stay experiences in the past year in Shandong province, and to explore its influencing factors on the willingness for downward referral.@*Methods@#Three prefecture-level cities in Shandong province were sampled by multi-stage stratified random sampling in August 2017. Questionnaire survey was conducted among 910 rural elderlies(over 60 years old)who had been hospitalized in the past year. The study included the basic information, the hospitalization experience, and perception of essential medicines system, ego-resiliency, the referral status and willingness for downward referral. Rank sum test, Chi-square test and t test were used for univariate analysis, and logistic regression was applied for influencing factors.@*Results@#Among 910 rural elderlies who had been hospitalized in the past year, 53(5.8%) were referred to other medical institutions in their recent hospitalization, and 597(65.6%)were willing to be referred downward. The main reason for their reluctance for downward referral was that the medical competency of primary medical institutions was low; and the main reason for willingness for downward referral was being close to home. The results showed that marital status, impression for the national essential medicines system and ego-resiliency were the influencing factors of their willingness to downward referral among rural elderlies who had been hospitalized in the past year(P<0.05).@*Conclusions@#The referral rate and willingness for downward referral among the rural elderlies in Shandong province are relatively low. We should further enhance the service capacity of primary medical institutions, strengthen the publicity and implementation of the national essential medicines system, pay attention to help with the elderlies′ negative emotions caused by diseases, and improve their ego-resiliency.
ABSTRACT
At present, general practitioners in China lack both specialist knowledge and ability, which calls for close cooperation between general practitioners and specialists to better guarantee medical quality and patient safety. The authors reviewed the connotation, research status, development trend, problems and suggestions of general practitioners-specialists joint consultation service. Based on such, they pointed out that such a general practitioner-specialist joint clinic is quite new in the country, but numerous literature has confirmed that it can not only make up for services fragmentation, but also reduce referral rate.Furthermore, it can improve the quality of people′s lives, improve the general practitioner′s professional knowledge and skills, standardize general practitioner′s rational drug use. All these prove the reform an effective measure and deserves further promotion and greater supervision.
ABSTRACT
Two-way referral system is an important measure to promote the rational distribution of medical resources and promote the health of patients, but now there is a typical characteristic of"referrals up easy but downward referral difficult". while the transitional care of downward referral patients is one of the important impetus to promote the implementation of downward referral, this paper summarizes the necessity, connotation, main service forms, application effects and problem analysis status of the transitional referral of patients in the two-way referral mode in our country, in order to provide the basis for the establishment of a nursing security system suitable for two-way referral of patients.
ABSTRACT
A two-way referral system for eye diseases management was developed between the Weifang community health service centers and Shanghai eye hospital in May 2014.With the “peer-to-peer” two-way referral model, the physicians in community health service center and ophthalmologists in eye hospital were directly responsible for screening , diagnosis and treatment of patients.The specialists of eye hospital also regularly provided clinic service in the center for longitudinal management of the patients .The “peer-to-peer” two-way referral model played a positive role in enhancing the cooperation between community health service center and superior hospital , upgrading skills of general practitioners, and improving the residents′satisfaction.
ABSTRACT
Objective To explore and discuss the factors for restricting the two-way referral system from the patient's perspective in order to promote the formation of hierarchical medical system in Changsha City.Methods The stratified random sampling method was adopted to divide the Chansha City into the 3 grades of high,middle and low according to the regional economical development situation,2 districts in one grade,including 6 districts.Then each district was redivided into high,middle and low grades according to the economic situation,2 basic medical institutions were selected from each grade.A total of 360 patients were randomly sampled for conducting the questionnaire investigation.The patients and doctors specially participating in the two-way referral conducted the deep interview.Results The patients choosing to primary hospital for first visit accounted for 60.9％.The awareness degree of patients to two-way referral system was 21.1％,and the two-way referral service satisfaction in the patients with two-way referral was 85.7 ％.The patients' will of transfer treatment from primary hospital to superior hospital in case of disease condition need was 82.9 ％.The patients' will for conducting rehabilitation treatment from superior hospital to primary hospital was 77.6 ％.Conclusion Few patients choose primary hospital for first visit.The signing rate of family contract services is low and awareness degree of two-way referral system is not high.
ABSTRACT
Objective: To explore the effects of the bi-directional referral system from the perspective of the medical service consumer.Methods: A balanced panel data which was adjusted by Propensity Score Matching was employed to evaluate the effects of two-way referral system using difference-in-difference (DID) for the 2013 and 2015 data.The evaluation indicators including actual cost sharing ration, out-of-pocket cost per unit, the possibility of high cost, annual inpatient visits and length of hospital stay per unit were used.Results: Compared with the control group, the two-way referral system resulted in an 11.3% (P<0.001) increase in actual cost sharing ratio and an increase of 0.710 (P<0.001) annual inpatient visits in the intervention group.However, the policy did not significantly reduce the possibility of high-cost medical expenses and reduce the length of hospitalization and the annual cost hospitalization.Conclusion: Based on the key findings of the analysis of this study, the two-way referral system has beneficial effects on reducing inpatient financial burden and optimizing resource allocation.
ABSTRACT
Hierarchical diagnosis and treatment is the top priority of health care reform,it will provide a solid institutional foundation and institutional protection for the construction of healthy China and the basic health care system.The paper summarizes the present practice of the hierarchical diagnosis and treatment in China,and analyzes the existing problems,on this basis puts forward corresponding countermeasures and suggestions as the references for the construction of hierarchical diagnosis and treatment and deepening reform.
ABSTRACT
In order to realize the seamless connection between superior and inferior medical institutions and simplify the process of patient referral to superior medical hospitals from the community medical institutions,Zhenjiang First People's Hospital designs a two-way referral platform for direct registration to Zhenjiang First People’s Hospital from community medical institutions.The paper introduces the design process,features and realization steps of this platform.The platform can realize the sharing of patient information between the community medical institutions and the hospital,facilitate patients' seeing a doctor and improve medical service level.
ABSTRACT
Covered in the paper is the practice of an information platform of a medical alliance centering on Wuxi People′s Hospital,and its application in 1 6 member hospitals.Thanks to the overall standardization,planning, construction, regulation and synergy of the members in tiered medical services,such a platform contributes positively in sharing management,technology and medical resources among the members.
ABSTRACT
The significance and contents of regional medical cloud construction based on information sharing were summarized according tothe three-circle theory, and the status quo and difficulties of the first diagnosis system, with the implementation of health information system for Xiamen residents as an example, and suggestions were pro-posed for the development of regional medical big data.
ABSTRACT
Recently , the country actively explores the pattern of an integrated healthcare which enables the as-sociation among hospitals of different levels , aimed to achieve maximum utilization of medical resources and lead a reasonable distribution of the patients .By reviewing the practices related to the integration of healthcare in Beijing , Shanghai , Zhenjiang and Wuhan city , this paper sums up in five typical mechanisms , i.e.organization and manage-ment mechanism , human resource management mechanism , interest distribution mechanism , service continuity and resources sharing mechanism .The effects of these practices were analyzed and the faced challenges were discussed . The following points were made clear during analysis and discussion:the sustainability of the collaboration mode and organization structure , human resource supports and incentive methods , health insurance guidance for hospitals and patients , two-way referral system and supporting measures , and building of information system .Then we put forward some suggestions , hoping to offer some references to the establishment of integrated healthcare in other regions .
ABSTRACT
〔Abstract〕 The paper explains the construction background and objective of the graded diagnosis information system based on the provincial health information platform in Zhejiang province and introduces the system framework and function in detail .This system pro-vides uniform referral information service for medical institutions at all levels all over the province and realizes the exchange and sharing of dual referral records between basic health service institutions and big hospitals .
ABSTRACT
The two-way referral system is an inevitable step in the health reform,as it could effectively channel patients,promote rational use of healthcare resources,and improve the quality of care at primary medical institutions.Only by means of resources integration for improvement of existing policies,and building a healthcare system comprising partnering medical institutions of all levels with proper division of responsibilities,can the two-way system come into practice smoothly.This will alleviate the difficulty in seeing doctors and expensiveness of treatment.
ABSTRACT
Analyzed in the paper is the present development of medical rehabilitation service system in Beijing,Changsha,and Urumqi,in an effort to identify key measures,and discover problems found with the policy environment and system building.Based on such findings,the authors proposed such measures as developing policies and regulations, optimizing resource allocation, strengthening training of rehabilitation personnel and greater publicity.
ABSTRACT
In recent years, the incidence of diabetes has been increasing year by year. Along with it, the problems of high medical cost and health resource shortage also make the diabetes the key chronic disease of health service management in our country. There are significant features and advantages in treatment of diabetes with traditional Chinese medicine. Therefore, the construction mode of two-way referral care for diabetes patients between TCM hospitals and community medical institutions is just unfolding. Based on the status quo of TCM treatment for diabetes, this article reviewed the present basic situation of the two-way referral care for diabetes patients in TCM hospitals and community medical institutions, discussed the significance of this mode for diabetes patients in TCM hospital, emphasized the feasibility and validity of implementing this mode, and provided beneficial exploration and consideration for further development of this mode for diabetes patients between TCM hospitals and community medical institutions.
ABSTRACT
The trial of two-way referral enrolled 26 patients with hypertension, including 20 cases of refractory hypertension, 3 new cases and 3 cases of secondary hypertension, the average length of follow-up was 22 d (10-35 d). The family physicians in Huaihaizhong Road Community Health Service Center communicated with specialists in the medical center (Ruijin hospital), appointments were made and medical information and other materials were sent in advance. When investigations and adjustment of medication were made, and the blood pressure was under control, patients were referred back to the community. This two-way referral system promoted the information exchanges between two side, doctors got prior knowledge about patients' condition and would spend more time with the patients; and patients' feeling of satisfaction and compliance of the treatment were increased. From our experiences, we suggest that the therapeutic regime made by the medical center should be feasible to the community, and more convenience should be given to the referred patients, so that the effectiveness and efficiency of the two-way referral can be further improved.
ABSTRACT
Objective To explore effective ways for community health service institutions to change patients' health service seeking patterns. Methods Yuetan Community Health Service Center of Fuxing Hospital affiliated to Capital Medical University and 9 community health service stations under its subordination in the 1996～2002 period were selected as a representative of the community health service institutions to be studied and intervened while the headquarters of Fuxing Hospital in the same period was selected as a representative of the third-tier hospitals to be studied. A comparison was made between the two in outpatient volume change. Questionnaires were distributed randomly to residents of the Yuetan area where Fuxing Hospital is located in order to study their health service seeking behaviors each year from 1996 to 2002. Results As a result of hard work in the 6 years, Yuetan Community Health Service Center saw a steady increase in outpatient volume whereas the headquarters of Fuxing Hospital witnessed a steady decrease in outpatient volume. Survey via questionnaires sent randomly to permanent residents of the Yuetan area indicated a change in residents' health service seeking patterns. Conclusion It is effective and viable for community health service institutions to change patients' health service seeking patterns through providing social-psychological-biological community medical services, enhancing health education and setting up a two-way referral system with third-tier hospitals.