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.

References

［1］钟艳宇，陈娟.我国医联体中双向转诊制度的实施现状及对策［J］．中国医药导报，2017，14（16）：154-158.3608
ZHONG Y Y，CHEN J.Current situation and strategy of two-way referral implementation in integrated delivery system of China［J］．China Medical Herald，2017，14（16）：154-158.3608
［2］中共中央、国务院关于卫生改革与发展的决定［EB/OL］．（1997-01-15）［2017-08-20］．http：//www.nhfpc.gov.cn/wsb/pM30115/200804/18540.shtml.3608
［3］国务院.关于城镇医药卫生体制改革的指导意见［EB/OL］．（2000-02-21）［2017-08-20］．https：//www.jdzx.net.cn/article/402881e4094442080109473d4662001f/2009/3/402881e4094442080109489009b9002e.html.3608
［4］国务院.国务院关于发展城市社区卫生服务工作的指导意见［EB/OL］．（2006-02-23）［2017-08-20］．http：//www.gov.cn/zwgk/2006-02/23/content_208882.htm.3608
［5］中共中央国务院关于深化医药卫生体制改革的意见［EB/OL］．（2009-04-06）［2017-08-20］．http：//www.gov.cn/jrzg/2009-04/06/content_1278721.htm.3608
［6］中华人民共和国国民经济和社会发展第十二个五年规划纲要［EB/OL］．（2011-03-16）［2017-08-20］．http：//www.hprc.org.cn/wxzl/wxysl/wnjj/diyigewnjh_1/201103/t20110316_153680_1.html.3608
［7］国务院办公厅.国务院关于推进分级诊疗制度建设的指导意见［EB/OL］．（2015-09-11）［2017-08-20］．http：//www.gov.cn/zhengce/content/2015-09/11/content_10158.htm.3608
［8］朱露，任文，任菁菁.浙江省双向转诊现状及问题分析［J］．全科医学临床与教育，2017，15（2）：175-177．DOI：10.13558/j.cnki.issn1672-3686.2017.02.016.3608
ZHU L，REN W，REN J J.Current situation and problem analysis of two-way referral in Zhejiang Province［J］．Clinical Education of General Practice，2017，15（2）：175-177．DOI：10.13558/j.cnki.issn1672-3686.2017.02.016.3608
［9］国家统计局.中国统计年鉴［M］．北京：中国统计出版社，2016.3608
National Bureau of Statistics.China statistical yearbook［M］．Beijing：China Statistics Press，2016.3608
［10］赵光斌，杜光会，林敏.制约双向转诊制度实施因素研究［J］．中国全科医学，2013，16（25）：2930-2932．DOI：10.3969/j.issn.1007-9572.2013.25.006.3608
ZHAO G B，DU G H，LIN M.Impacting factors to implementation of the two-way referral system［J］．Chinese General Practice，2013，16（25）：2930-2932．DOI：10.3969/j.issn.1007-9572.2013.25.006.3608
［11］贾继荣，高广颖，梁民琳，等．黑龙江省新农合分级诊疗制度实施情况及对策研究［J］．中国医院管理，2016，36 （1）：5-7.3608
JIA J R，GAO G Y，LIANG M L，et al．Implementation and countermeasure on the NRCMS' hierarchical diagnosis and treatment in Heilongjiang province［J］．Chinese Hospital Management，2016，36 （1）：5-7.3608
［12］王轲，叶青.双向转诊工作的现状原因及对策——以T市区为例［J］．医学与法学，2013，5（5）：72-74.3608
WANG K，YE Q.Cause of current situation and its countermeasures to two-way referral work——take T city as an example［J］．Medicine and Law，2013，5（5）：72-74.3608
［13］张明妍，丁晓燕，高运生.我国社区卫生服务机构服务能力现状、问题及对策［J］．中国卫生事业管理，2016，33（9）：654-656，681.3608
ZHANG M Y，DING X Y，GAO Y S.An investigation of medical and public health services of community health centers［J］．Chinese Health Service Management，2016，33（9）：654-656，681.3608
［14］刘亚军，冯志兰，李楠，等．北京市社区卫生服务双向转诊现况研究［J］．中国全科医学，2009，12（21）：2006-2008．DOI：10.3969/j.issn.1007-9572.2009.21.030.3608
LIU Y J，FENG Z L，LI N，et al．Current status of the two-way referral between community health service institutions and hospitals in Beijing［J］．Chinese General Practice，2009，12（21）：2006-2008．DOI：10.3969/j.issn.1007-9572.2009.21.030.3608
［15］赖伟，陈敏生，王立义，等．上海市不同区域双向转诊现状与医患认知度分析［J］．中国卫生质量管理，2011，18（2）：59-61．DOI：10.3969/j.issn.1006-7515.2011.02.022.3608
LAI W，CHEN M S，WANG L Y，et al．Current situation and awareness of dual referral in Shanghai different districts［J］．Chinese Health Quality Management，2011，18（2）：59-61．DOI：10.3969/j.issn.1006-7515.2011.02.022.3608
［16］陈丽娜，葛孟华，郑国平，等．区镇一体化紧密型医联体运行效果分析［J］．中国现代医生，2016，54（23）：125-128.3608
CHEN L N，GE M H，ZHENG G P，et al．Operation effect analysis of district-town integrated close medical consortium［J］．China Modern Doctor，2016，54（23）：125-128.3608
［17］朱小颖，夏海晖，匡莉.社区全科医生转诊模式描述性框架的构建［J］．卫生经济研究，2014，31（5）：30-34.3609
ZHU X Y，XIA H H，KUANG L.Construction of descriptive frame of general practitioner referral model in primary healthcare organization［J］．Health Economics Research，2014，31（5）：30-34.3609
［18］庞伦祥，赖远全，梁永华，等．高血压患者双向转诊临床路径的探讨与分析［J］．中国全科医学，2012，15（36）：4237-4239．DOI：10.3969/j.issn.1007-9572.2012.36.100.3609
PANG L X，LAI Y Q，LIANG Y H，et al．Discussion and analysis of hypertensive patients with two-way referral clinical path［J］．Chinese General Practice，2012，15（36）：4237-4239．DOI：10.3969/j.issn.1007-9572.2012.36.100.3609
［19］颜霏，陈惠芳，李济宇，等．医疗联合体内冠心病双向转诊实施效果评价［J］．中国医院，2015，19（8）：46-47．DOI：10.3969/j.issn.1671-0592.2015.08.020.3609
YAN F，CHEN H F，LI J Y，et al．Effectiveness assessment on coronary heart disease dual referral in medical association［J］．Chinese Hospitals，2015，19（8）：46-47．DOI：10.3969/j.issn.1671-0592.2015.08.020.3609
［20］李安乐，张蓉.城市社区糖尿病患者双向转诊的效果评估［J］．中华糖尿病杂志，2013，5（12）：750-753．DOI：10.3760/cma.j.issn.1674-5809.2013.12.009.3609
LI A L，ZHANG R.Effects of two-way referral care of patients with type 2 diabetes in urban community in Shanghai［J］．Chinese Journal of Diabetes，2013，5（12）：750-753．DOI：10.3760/cma.j.issn.1674-5809.2013.12.009.3609
［21］梁思园，何莉，宋宿杭，等．我国医疗联合体发展和实践典型分析［J］．中国卫生政策研究，2016，9（5）：42-48．DOI：10.3969/j.issn.1674-2982.2016.05.008.3609
LIANG S Y，HE L，SONG S H，et al．The development and practice of integrated healthcare in China［J］．Chinese Journal of Health Policy，2016，9（5）：42-48．DOI：10.3969/j.issn.1674-2982.2016.05.008.3609
［22］国家卫生计生委.关于做好高血压、糖尿病分级诊疗试点工作的通知［EB/OL］．（2015-12-01）［2017-08-20］．http：//www.nhfpc.gov.cn/yzygj/s3593g/201512/073b50bd7d2b4454872126f2bc830410.shtml.3609
［23］阮芝芳，陈辉，杨佳琦，等．杭州市拱墅区“无缝链接”双向转诊模式的实践与探讨［J］．中国农村卫生事业管理，2013，33（6）：620-622.3609
RUAN Z F，CHEN H，YANG J Q，et al．Practice and exploration of the two-way referral model in Gongshu district of Huangzhou［J］．Chinese Rural Health Service Administration，2013，33（6）：620-622.3609
［24］江萍，陈支援，缪栋蕾，等．上海市长宁区构建区域医疗联合体的政策效果、经验与建议［J］．中国卫生政策研究，2013，6（12）：19-24．DOI：10.3969/j.issn.1674-2982.2013.12.004.JIANG P，CHEN Z Y，MIAO D L，et al．Implementing the regional medical association in Changning district，Shanghai：policy effectiveness，experience and recommendations［J］．Chinese Journal of Health Policy，2013，6（12）：19-24．DOI：10.3969/j.issn.1674-2982.2013.12.004.3609
［25］张奕标，何丽丽，单蕾，等．绑定社康政策下社区双向转诊的作用［J］，检验医学与临床，2014，11（14）：2035-2037．DOI：10.3969/j.issn.1672-9455.2014.14.069.3609
ZHANG Y B，HE L L，SHAN L，et al．Impact of the policy “binding primary healthcare organization” upon the two-way referral［J］．Laboratory Medicine and Clinic，2014，11（14）：2035-2037．DOI：10.3969/j.issn.1672-9455.2014.14.069.3609
［26］魏晓静.新医改背景下上海市医疗保险支付模式研究［D］．上海：上海工程技术大学，2014.3609
WEI X J.The research on medical isurance payment mode in Shanghai under the background of new medical reform［D］．Shanghai：Shanghai University of Engineering Science，2014.3609
［27］蔡卓.上海城市社区卫生服务补偿研究［D］．上海：复旦大学，2002.3609
CAI Z.Study on the reimbursement of community health services in Shanghai［D］．Shanghai：Fudan University，2002.3609
［28］孙晓峰，刘源，朱有为，等．双向转诊绩效评价体系的构建［J］．解放军医院管理杂志，2015，22（5）：412-414.3609
SUN X F，LIU Y，ZHU Y W，et al．Establishment of performance evaluation system for two-way referral［J］．Hospital Administration Journal of Chinese People's Liberation Army，2015，22（5）：412-414.3609
［29］季慧敏，田侃，喻小勇.家庭医生式服务的现状及推进对策［J］．广西医学，2015，37（10）：1531-1533.DOI：10.11675/j.issn.0253-4304.2015.10.50.3609
JI H M，TIAN K，YU X Y.Current situation and promotion measure of family physician's service［J］．Guangxi Medical Journal，2015，37（10）：1531-1533.DOI：10.11675/j.issn.0253-4304.2015.10.50.3609
［30］程才，唐圣春，刘高伍，等．双向转诊的转诊水平研究［J］．医学与社会，2008，21（3）：22-23，27．DOI：10.3870/j.issn.1006-5563.2008.03.008.3609
CHENG C，TANG S C，LIU G W，et al．Studies on the referral level of two-way referral［J］．Medicine and Society，2008，21（3）：22-23，27．DOI：10.3870/j.issn.1006-5563.2008.03.008.3609
［31］马亚楠，何钦成.社区全科医生首诊制是实现双向转诊制的有效途径［J］．中国卫生经济，2007，26（3）：27-29．DOI：10.3969/j.issn.1003-0743.2007.03.008.3609
MA Y N，HE Q C.The system of the first treatment in the community the good route to the dual referral ［J］．Chinese Health Economics，2007，26（3）：27-29．DOI：10.3969/j.issn.1003-0743.2007.03.008.3609
［32］程本坤，李伟明，苏黛丝，等．基于乡镇卫生院/站及医生的区域新农合双向转诊现状调查［J］．中国全科医学，2012，15（22）：2564-2566．DOI：10.3969/j.issn.1007-9572.2012.08.025.3609
CHENG B K，LI W M，SU D S，et al．Two-way referral in regional township hospitals / health stations within new rural cooperative medical service［J］．Chinese General Practice，2012，15（22）：2564-2566．DOI：10.3969/j.issn.1007-9572.2012.08.025.3609
［33］梅玲明，陈翔，杨冬仙，等．县-社区医疗联动规范转诊管理的实践［J］．中国全科医学，2014，17（36）：4378-4380．DOI：10.3969/j.issn.1007-9572.2014.36.028.3609
MEI L M，CHEN X，YANG D X，et al．Practice of standardized referral management based on county-community medical linkage［J］．Chinese General Practice，2014，17（36）：4378-4380．DOI：10.3969/j.issn.1007-9572.2014.36.028.3610
［34］梁震宇.通过网络技术进行双向转诊信息传输与考核的实践及效果［J］．中国全科医学，2011，14（17）：1955-1956．DOI：10.3969/j.issn.1007-9572.2011.17.028.3610
LIANG Z Y.Information trasmission and assessment of two-way referral through network technology：practice and effects ［J］．Chinese General Practice，2011，14（17）：1955-1956．DOI：10.3969/j.issn.1007-9572.2011.17.028.3610
［35］袁芳.信息化建设在我院双向转诊工作中的优势［J］．大家健康（学术版），2015，9（5）：283.3610
YUAN F.The role of informational construction in the two-way referral ［J］．For All Health，2015，9（5）：283.3610
［36］郭庆.“BAT全覆盖”智慧医院的探索与实践［J］．海南医学，2015，26（16）：2466-2467．DOI：10.3969/j.issn.1003-6350.2015.16.0892.3610
GUO Q.The exploration and practice of “BAT full coverage” the intelligent hospital［J］．Hainan Medical Journal，2015，26（16）：2466-2467．DOI：10.3969/j.issn.1003-6350.2015.16.0892.3610
［37］吴涵梅，李跃平.双向转诊制度现状以及经验概述［J］．中国农村卫生事业管理，2010，27（7）：661-662．DOI：10.3969/j.issn.1004-4663.2010.07.003.3610
WU H M，LI Y P.Discussing the status of two-way referral system and experiences from it［J］．Chinese Rural Health Service Administration，2010，27（7）：661-662．DOI：10.3969/j.issn.1004-4663.2010.07.003.3610
［38］国务院办公厅.国务院办公厅关于推进医疗联合体建设和发展的指导意见［EB/OL］．（2017-04-26）［2017-08-20］．http：//www.gov.cn/zhengce/content/2017-04/26/content_5189071.htm.3610
［39］陆媛，范会芹，王朝昕，等．我国双向转诊的突破口剖析［J］．中国全科医学，2017，20（10）：1168-1172，1180．DOI：10.3969/j.issn.1007-9572.2017.10.005.3610
LU Y，FAN H Q，WANG Z X，et al．Breakthrough of the two-way referral in China［J］．Chinese General Practice，2017，20（10）：1168-1172，1180．DOI：10.3969/j.issn.1007-9572.2017.10.005.3610

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