Efficacy，Problems and Current Status of Two-way Referral from 1997 to 2017 in China：a Systematic Review

doi:10.12114/j.issn.1007-9572.2018.00.033

Abstract

Abstract: Objective　This study aimed to understand the history and efficacy of the two-way referral in China from 1997 to 2017，as well as its current status，to analyze existing problems，and to propose suggestions for further improvement of the system.Methods　This study was conducted from May 2017 to January 2018.Systematic review was used，and multiple key words and key words combinations such as “two-way referral and current situation”“two-way referral and efficacy” and “two-way referral and problems” were used to search the Wanfang Data Knowledge Service Platform，the China Science and Technology Journal Database，CNKI，Baidu Scholar，and Google Scholar，as well as national and provincial health administrative websites.Chinese literature on the current status，efficacy and problems in the two-way referral was retrieved.Results　A total of 232 studies were included and further analyzed.The two-way referral in China has developed rapidly.The number of referred patients and the utility of primary health service have been steadily increasing for years.However，the quality of the two-way referral still had some problems，for example，upward-referred patients were much more numerous than downward-referred patients，referral standards and the accompanying insurance policies were insufficient，incentives and regulatory mechanisms were incomplete，and the competence of primary health care personnel needed improvement.Conclusion　More improvements are necessary in further development of the two-way referral，including adoption of more supportive policies，establishment of an appropriate incentive system and a utility system for the primary health workforce，improvement in the competence of primary health care personnel，and balancing the interests of all-level health institutes.

Key words: Patient transfer, Two-way referral, Current situation, Medical consortium, Systematic review

摘要： 目的　了解我国1997—2017年双向转诊的发展历程、实施现状及效果，分析问题并提出建议，为我国双向转诊制度进一步发展提供理论依据。方法　2017年5月—2018年1月，采用系统综述的方法，以“双向转诊+现状”“双向转诊+效果”及“双向转诊+问题”等为检索词，检索万方数据知识服务平台、中国科技期刊数据库、中国知网、百度学术及谷歌学术等主要中文数据库，以及国家及各省卫生和计划生育委员会网站，获取1997—2017年发表的关于双向转诊现状、效果及问题的中文文献。结果　共纳入232篇文献进行系统评价。文献显示，我国双向转诊发展势头良好，转诊人次逐年增加，基层医疗卫生机构就诊人次稳步提升，但双向转诊质量存在较大问题，其中，向上转诊人次数远超向下转诊，缺乏转诊标准及配套的医保政策、激励和监管制度不完善、基层医疗人员服务水平偏低等问题较为突出。结论　我国双向转诊制度尚需进一步发展和完善，应从统筹全局出发，着重完善相关配套政策，建立基层人员合理使用和激励机制，提升基层医疗队伍能力，扭转各医疗机构间不同利益驱动。

关键词: 病人转诊, 双向转诊, 现状, 医联体, 系统评价

SHEN Ying,HUANG Weiran,JI Shuyu, et al. Efficacy，Problems and Current Status of Two-way Referral from 1997 to 2017 in China：a Systematic Review　[J]. Chinese General Practice, 2018, 21(29): 3604-3610. DOI: 10.12114/j.issn.1007-9572.2018.00.033.
申颖,黄为然,纪舒妤等. 1997—2017年我国双向转诊现状和效果及问题的系统评价[J]. 中国全科医学, 2018, 21(29): 3604-3610. DOI: 10.12114/j.issn.1007-9572.2018.00.033.

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