关键词: 病人转诊, 双向转诊, 分级诊疗, 满意度, 影响因素分析, 数据收集

Abstract: Background The 'Healthy China' strategy was proposed at the 19th CPC National Congress, demanding deepening the reform of the pharmaceutical and healthcare system and comprehensively establishing a high-quality and high-efficient medical and health service system.As an important part of the hierarchical medical system, bidirectional referral system is still in its initial development stage.Its further development and improvement needs constant research and exploration.Objective　To investigate residents' support for and satisfaction with the bidirectional referral system, and discuss the influencing factors, providing countermeasures and suggestions for the implementation of the system.Methods By use of multi-stage stratified random sampling, 1 550 residents were selected as the participants from July to August 2016.A self-made questionnaire was used to investigate the participants concerning personal data, support for and satisfaction with bidirectional referral system.Comparisons of support for and satisfaction with bidirectional referral system were made by personal data.Multivariate Logistic regression was used to analyze the influencing factors for level of support and satisfaction for the system.Results　The survey achieved a response rate of 95.0%（1 473/1 550）．The rate of support for bidirectional referral system was 53.8%（793/1 473）．The level of support for bidirectional referral system in the respondents differed significantly by marital status，annual healthcare expenditure，treatment in primary care in the past year，referral experience，approval of compulsory initial consultation in primary care，awareness of hierarchical medical system and support for hierarchical medical system（P<0.05）．Multivariate Logistic regression analysis showed that marital status, annual healthcare expenditure, referral experience, approval of compulsory initial consultation in primary care, and support for hierarchical medical system were associated with the level of support for bidirectional referral system（P<0.05）．Of the 435 respondents with referral experience, 433（99.5%） answered referral satisfaction questions, among whom 133 （ 30.7% ） were satisfied with the referral, 101 （ 23.3% ） were dissatisfied with the referral, and 199（46.0%） gave a neutral evaluation of the referral.Those who approved compulsory initial consultation in primary care showed higher level of satisfaction with bidirectional referral system than those disapproved 〔39.9%（83/208）vs 22.2%（50/225）〕（χ2=15.878，P<0.001）．Those who were in support of hierarchical medical system showed higher level of satisfaction with bidirectional referral system than those who were not〔35.5%（107/301）vs 19.7%（26/132）〕（χ2=10.834，P=0.001）．Those who were in support of bidirectional referral system showed higher level of satisfaction with bidirectional referral system than those who were not〔38.5%（74/192）vs 24.5%（59/241）〕（χ2=9.927，P=0.002）．Complicated procedures, inconvenient reimbursement of medical insurance and lack of information exchange were seen as the inadequacies during the implementation of bidirectional referral system.Conclusion　The levels of support for and satisfaction with bidirectional referral system are low in Xuzhou's residents, which are influenced by insufficient publicity, and inadequate implementation details of the bidirectional referral system as well as the unsatisfactory quality of medical services.In view of this, precise drumbeating of bidirectional referral system should be intensified in both healthcare workers and residents, the referral process should be optimized, and the service capacities of primary care should be improved.

Key words: Patient transfer, Two-way referral system, Hierarchical diagnosis and treatment system, Satisfaction, Root cause analysis, Data collection