Abstract: Background　Transferring contracted residents with a disease that cannot treated in the community health center to a higher level hospital via an appointment made in advance，is an important contracted task for family doctors，and is also a basis of implementing the hierarchical medical policies.Objective　To investigate the implementation of referral appointments in contracted residents，providing a theoretical basis for further improvement and popularization of the services.Methods　This study was conducted in 240 contracted patients from Minhang District Pujin Community Health Center（MDPCHC），including 120 with an experience of ever being transferred to a higher level hospital from MDPCHC after making an appointment in advance（appointment group） during January to June 2019，and 120 randomly selected cases with the record of seeking healthcare in a higher level hospital during the same period but without making an appointment（non-appointment group）.Basic general data and appointed referral data of the appointment group were collected from Shanghai Family Doctor Referral Appointment Platform.A telephone questionnaire survey based on hierarchical diagnosis and treatment and family doctor services was conducted in both groups.The influence of implementing referral appointments on relevant business development was analyzed.Results　The mean age of the appointment group was（65.4±8.7） years old，most of whom were elderly people.The average number of referral appointments was（1.5±1.0），and the average appointment period was（13.2±11.4） days.The hospital with the highest number of appointments was Southern Division of Renji Hospital，accounting for 70.1%（124/177） of the total appointment.The department with the highest number of appointments was digestive department（22.0%，39/177）.The survey showed that both groups' patients showed significant differences in the awareness rates of names of their contracted family doctors，and specific contents of contracted family doctors services，level of satisfaction with contracted family doctors services，community health services，and with the services delivered by the local general hospitals（P<0.05）.Conclusion　The implementation of the policies concerning referral appointments by family doctors has facilitated contracted residents to access to the registration of higher level hospitals，increased their awareness of and satisfaction with relevant medical services，and is conducive to the development of hierarchical diagnosis and treatment.To further take the advantages of making appointments with specialists working at higher level hospitals by the family doctor，it is suggested to strengthen the propaganda and use frequency of the referral appointment platform，ensure the implementation of family doctor services by the cooperative institutions of the medical consortium，increase the number of specialist appointments of the department with high-frequency referral appointments，and reduce the referral waiting time of the patients as far as possible.

Key words: Contracted family doctor services, Community residents, Appointment referral, Hierarchical diagnosis and treatment

摘要： 背景　对于无法在社区卫生服务中心诊疗的疾病，通过预约转诊通道将签约居民转至上级医院进一步诊治是家庭医生签约服务的一项重要内容，是国家实施分级诊疗政策的基础。目的　分析家庭医生预约转诊服务开展情况，为其进一步改善与推广提供理论依据。方法　查看2019年1—6月浦锦社区卫生服务中心上海市家庭医生预约转诊信息平台，收集120例预约转诊患者基本资料和预约转诊信息平台的使用情况（预约组）。采用随机数字表法，抽取已签订家庭医生并在研究时间段内有过上级医院就诊记录但未预约转诊的患者120例（未预约组）。对预约组和未预约组的患者开展基于分级诊疗与家庭医生服务的电话问卷调查，分析预约转诊服务对相关业务开展的影响。结果　预约组平均年龄（65.4±8.7）岁，以老年人居多，人均预约转诊（1.5±1.0）次，平均预约周期（13.2±11.4）ｄ；预约人次数最多的医院为上海交通大学医学院附属仁济医院南院，占70.1%（124/177），预约人次数最多的科室为消化科，占22.0%（39/177）。通过电话调查得知，两组研究对象在家庭医生姓名知晓率、家庭医生签约内容知晓率、家庭医生签约服务满意度、社区卫生服务满意度、区域综合医院服务满意度方面比较，差异有统计学意义（P<0.05）。结论　家庭医生预约转诊服务政策的实施，方便了签约居民获得上级医院号源，提高了签约居民对相关医疗服务的知晓率、满意度，有利于分级诊疗工作的开展。应加强预约转诊平台的宣传力度，增加使用频次，医联体合作单位应加强对家庭医生服务的保障力度，提高预约频次较高科室的专家号源开放数量，避免患者过长的等待时间，进一步突出通过家庭医生预约上级医院专家号源的优势。

关键词: 家庭医生签约服务, 社区居民, 预约转诊, 分级诊疗