关键词: 分级诊疗, 双向转诊, 病人满意度, 影响因素分析

Abstract: Objective　To investigate the level and associated factors of patients' satisfaction with the procedures for upward referral-to-downward referral during the implementation of hierarchical medical system.Methods　We conducted a survey in a sample of 415 patients from those who were transferred to an affiliated hospital of a medical college in Xi'an from lower-level institutions between November 2016 and May 2017 with a self-designed questionnaire for obtaining the data about sociodemographic characteristics，levels of satisfaction with the services delivered by the lower-level and upper-level medical institutions，level of satisfaction with the procedures for upward and downward referrals.A total of 400 returned responsive questionnaires，achieving a response rate of 96.4%.Results　The patients' satisfaction was found to be 30.0%（120/400），81.8%（327/400），65.5%（262/400），48.3%（28/58），for services delivered by the lower-level and upper-level medical institutions，the procedure for upward referrals，and the procedure for downward referrals，respectively.Multivariate logistic regression analysis showed that patients' age，satisfaction with the capabilities of healthcare professionals，service attitude of health workers and healthcare cost were associated factors for patients' satisfaction with the services delivered by lower-level medical institutions（P<0.05）；patients' mean monthly income and type of medical insurance，patients' satisfaction with the capabilities of healthcare professionals，service attitude of health workers，healthcare cost and the environment in healthcare settings were associated factors for patients' satisfaction with the services delivered by upper-level medical institutions（P<0.05）；patients' age and educational level，patients' satisfaction with the convenience of referral procedure and duration of referral were associated factors for their satisfaction with the procedure for upward referrals（P<0.05）；patients' educational level，satisfaction with the convenience of referral procedure and duration of referral were associated factors for their satisfaction with the procedure for downward referrals（P<0.05）.Conclusion　The services delivered by the upper-level medical institutions and the procedure for upward referrals achieved high levels of patients' satisfaction，but the procedure for downward referrals achieved low level of patients' satisfaction，the services delivered by the lower-level medical institutions，even worse，achieved the lowest level of patients' satisfaction.Patients' age and educational level，capabilities of healthcare professionals，service attitude of health workers toward patients，healthcare cost，convenience of the referral procedure，and duration of the referral were associated factors for patients' satisfaction with the procedures for upward referral-to-downward referral.

Key words: Hierarchical medical system, Two-way referral, Patient satisfaction, Root cause analysis