基于双向转诊的城郊社区卫生服务中心差异性研究  

Bi-directional Referrals in Urban and Suburban Community Health Centers:a Comparative Study

作　　者：史晓晓 宋徽江 葛许华 金花 王朝昕 杨森 宋扬 何娟媚 朱敏洁 于德华[1,2,3,4] SHI Xiaoxiao;SONG Huijiang;GE Xuhua;JIN hua;WANG Zhaoxin;YANG Sen;SONG Yang;HE Juanmei;ZHU Minjie;YU Dehua(Department of General Practice,Yangpu Hospital,Tongji University School of Medicine,Shanghai 200090,China;Academic Department of General Practice,Tongji University School of Medicine,Shanghai 200090,China;Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China;Shanghai General Practice Clinical Quality Control Center,Shanghai 200090,China;Caolu Community Health Center,Pudong New Area,Shanghai 201209,China;School of Public Health,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]同济大学附属杨浦医院全科医学科,上海市200090 [2]同济大学医学院全科医学系,上海市200090 [3]上海市全科医学与社区卫生发展研究中心,200090 [4]上海市全科医学临床质量控制中心,200090 [5]上海市浦东新区曹路社区卫生服务中心,201209 [6]上海交通大学医学院公共卫生学院,上海市200025

出　　处：《中国全科医学》2021年第1期30-35,共6页Chinese General Practice

基　　金：上海市卫生健康委员基金项目(20194Y0466);上海市领军人才(YDH-20170627);同济大学附属杨浦医院院级课题项目(Sel201844)。

摘　　要：背景当前医疗改革的大背景下,双向转诊是公立医院综合改革的基本目标之一。由于我国卫生资源分布不均,不同行政区在医疗资源、人力资源分布及诊疗管理上存在诸多差异,导致城区与郊区双向转诊情况不尽相同。了解城区与郊区的双向转诊情况对于更好实现资源利用最大化有重要意义。目的调查分析上海市城市与郊区社区卫生服务中心双向转诊开展实施现况,发现二者差异,并提出合理化建议,为上海市更好地推行双向转诊提供切实可靠的参考依据。方法于2018年11—12月,选取涵盖上海市16个行政区的244家社区卫生服务中心的行政负责人及4047例全科医生进行问卷调查。对行政管理人员调查的主要内容包括基本情况和双向转诊的组织机制、过程、转诊效果情况;对全科医生调查的主要内容包括基本情况和双向转诊方式、上转转诊联系方式、是否填写除转诊单之外的转诊信息、接收下转患者时是否与上级医生保持联络等。结果共发放社区行政管理问卷244份,回收有效问卷244份,问卷有效回收率100.00%;共发放全科医师问卷4047份,回收有效问卷3925份,有效回收率96.98%。3925例全科医生中,在郊区工作2641例(32.71%),在城区工作1284例(67.29%)。城市和郊区全科医生性别、职称、工作年限比较,差异有统计学意义(P<0.05)。97.54%(238/244)的社区卫生服务中心建立了双向转诊制度,89.34%(218/244)的社区卫生服务中心与二三级医院签订了双向转诊协议。城区与郊区社区卫生服务中心在设立双向转诊专门联络负责人、建立双向转诊档案、专门设置预留床位保证接收下转患者、双向转诊方式中的网络联系、点对点与相应专家或科室联系、与相应上级医院负责双向转诊的专门联系人联系等方面比较,差异有统计学意义(P<0.05)。50.41%(123/244)的社区卫生服务中心每月上转患者<100例,75.00Background Realizing successful bi-directional referrals is an essential target of the comprehensive medical reform for public hospitals launched in 2009 in China.Bi-directional referrals in urban and suburban areas are different due to domestic uneven distribution of health resources,and administrative regional differences of medical and human resources as well as disease management.It is of great significance to understand bi-directional referrals in urban and suburban areas to maximize the utilization of health resources.Objective To perform a comparative analysis of bi-directional referrals in urban and suburban community health centers(CHCs)in Shanghai with reasonable suggestions proposed,providing a practical and reliable reference for better promoting such services in Shanghai.Methods From November to December 2018,244 administrators and 4047 general practitioners(GPs)were enrolled from 244 CHCs in 16 districts of Shanghai.A survey was conducted among the administrators using a self-developed questionnaire(for administrators)for collecting their demographic data,and their perceptions of organizational mechanism,process and results of referrals.And another survey was conducted in the GPs using a self-developed questionnaire(for GPs)for collecting the data about demographics,modes of bi-directional referrals and contact ways for upward referrals used,prevalence of filling the referral information except the referral form,and prevalence of communicating with physicians in the higher level hospital when receiving the downward referred patient.Results The two surveys achieved response rates of 100.00%(244/244)and 96.98%(3925/4047),respectively.Of the 3925 GP respondents,2641(32.71%)worked in suburbs and 1284(67.29%)in urban areas.There were significant differences in gender ratio,distribution of title and working years between urban and suburban GPs(P<0.05).Of the CHCs,97.54%(238/244)established a bi-directional referral system,and 89.34%(218/244)signed a bi-directional referral agreement with secondary and ter

关 键 词：分级诊疗 病人转诊 社区卫生服务 社区卫生中心 全科医生 城郊差异 

分 类 号：R197[医药卫生—卫生事业管理]