三家医联体主体医院双向转诊现状分析及建议  

Analysis on the two-way referral by leading hospitals of three health alliances

作　　者：易利华[1] 黄培[1] 江淑秋[1] 郝爱民[1] 赵霞[1] 瞿甦[1] 韩志君[1] 邢明[1] 丁利华 林婧[3] 许心周 杨晓龙[1] 

机构地区：[1]无锡市第二人民医院,214002 [2]武汉市第五医院社管办 [3]上海交通大学医学院附属瑞金医院社管办

出　　处：《中华医院管理杂志》2015年第4期253-256,共4页Chinese Journal of Hospital Administration

基　　金：无锡市卫生局2012年重大项目（G201203）

摘　　要：目的：了解不同类型医联体主体医院社区首诊、双向转诊执行情况及托管模式内在动因,为可持续推进医联体提供科学依据。方法自制问卷调查,在3种类型医联体主体医院上海 A 医院、湖北 B 医院、江苏 C 医院医务人员中发放,同时进行访谈。结果3家医院均认为有必要推动社区首诊和双向转诊,推动影响因素差异有统计学意义（P 〈0.05）,A 医院54%、C 医院36%认为要建立全民医保体系；托管制模式选择3家医院差异有统计学意义（P〈0.05）,B 医院85%、C 医院63%认为紧密型,A医院66%认为松散型,3家医院均认为实行直管的最主要障碍是体制因素。结论双向转诊已成为医联体的纽带,但更应建立紧密型医联体,同时推行直管托管模式,在推行医联体的过程中要区域规划、运行机制、利益分配、医保政策、知信行统一统筹兼顾。Objective To learn the practice of first contact option and two-way referral,and the internal motivation of hospital hosting at different types of health alliances,for providing scientific evidences for continuous improvement of such alliances.Methods Customized questionnaires were distributed and interviews made at three leading hospitals of various alliances,including Hospital A in Shanghai,Hospital B in Hubei,and Hospital C in Jiangsu.Results All the three hospitals agreed to embrace the first contact and two-way referral,with statistical significance in their different impact factors for the acceptance （P〈 0.05 ）.54% in Hospital A and 36% in Hospital C agreed to establish the universal medical insurance system.In terms of hosting model selection,differences of the three hospitals are statically significant（P〈0.05）.85%in Hospital B and 63% Hospital C preferred the close type while 66% in Hospital A preferred the loose type.All the three hospitals admitted that institutional factors constitute the main obstacle against vertical management.Conclusion Two-way referral has become the bridge of health alliances,but it is urgent to build close alliances while promoting vertical hosting model.It is also suggested to give overall consideration to regional planning,operation system,and medical insurance policies,as well as overall KAP （knowledge,attitude,and performance）in promoting health alliances.

关 键 词：医联体 主体医院 托管 双向转诊 

分 类 号：R197.1[医药卫生—卫生事业管理]