The implementation of bi-directional referrals may be affected directly by physicians since they play a crucial role in the process, but their performance in which will be facilitated by an orderly, efficient and interconnected referral system. So exploring the impact mechanism of informatization on physicians' performance in bi-directional referrals will greatly promote the implementation of such referrals and the development of hierarchical diagnosis and treatment.

To develop a qualitative model explaining the influence of informatization on physicians' intentions and behaviors regarding patient referrals, laying a foundation for relevant empirical research.

In April to October 2021, we performed a systematical review of studies about the influence of informatization on patient referrals collected from databases of CNKI, Wanfang Data, PubMed and Web of Science, then based on this and the framework of the Theory of Planned Behavior (TPB) , we developed a theoretical model explaining the impact of informatization on physicians' intentions and behaviors concerning patient referrals with self-defined latent variables and self-selected observed variables incorporated. After that, we used the theoretical model and the technology acceptance model to analyze patient referrals, then developed a corresponding business model.

The theoretical model contains six latent variables including behavior, intention, attitudes, subjective norm, perceived behavior control and informationization control-related factors, and observed variables for measuring each of the latent variables. The relationships between latent variables could be divided into correlation/covariance relationship and causality relationship. The business model could clearly reflect the influence of different levels of informatization on physicians' intention and behavior related to patient referrals. The business model indicates that the implementation of bi-directional referrals could be promoted with reduced difficulty only when information support sustains referral services delivered by hospitals in a collaborative way with patient information linked and shared, information system is further improved, and referral standards and information platforms are deeply integrated.

The development of this qualitative model may be a reference for constructing a quantitative model, and for the development of a bi-directional referral assessment system and the formulation of relevant policy documents in China, and may expand the applicable scope of the TPB.

医生是双向转诊中的关键角色，直接影响着双向转诊的执行，而有序、高效、互联互通的转诊系统有助于促进医生进行双向转诊。探究信息化对医生双向转诊的影响机制，对于促进双向转诊、实现分级诊疗具有十分重要的意义。

构建信息化对医生转诊意向和行为影响的定性模型，为后续实证研究奠定基础。

于2021年4—10月，系统检索中国知网、万方数据知识服务平台、PubMed、Web of Science中与本研究构建模型相关的文献。基于计划行为理论，结合文献检索情况，对模型涉及的潜变量进行内涵界定和观察变量选取，进而构建信息化对医生转诊意向及行为影响的理论模型。结合理论模型，基于技术接受模型进行业务分析，构建相应的业务模型。

构建的信息化对医生双向转诊意向及行为影响的理论模型，确定了行为、意向、态度、主观规范、知觉行为控制、信息化控制因素6项潜变量，以及各潜变量的观察变量。各潜变量间的关系可分为相关/共变关系、因果关系。构建的业务模型可以清晰反映信息化的不同发展水平对医生转诊意向及行为的影响。业务模型显示，只有当信息化支撑在联通与共享的基础上支撑业务协同、信息系统功能完善且转诊标准与平台深度融合时，才能真正降低转诊的难度并促进双向转诊。

本研究构建的定性模型可以为下一步开展相应定量模型研究提供理论基础，也可以为我国双向转诊评价体系的构建和相关政策文件的制定提供参考，同时也拓展了计划行为理论的适用范畴。