复旦儿科医联体双向转诊在上海市松江区的实践与成效  

Practice and effect of bi-direction referral of Fudan Pediatric Medical Alliance in Songjiang District,Shanghai

作　　者：侯佳 张丽斐 陈曦 谢志玉 胡诤贇 刘冲 陈国宏[2] 翟晓文 黄国英 HOU Jia;ZHANG Li-fei;CHEN Xi;XIE Zhi-yu;HU Zheng-yun;LIU Chong;CHEN Guo-hong;ZHAI Xiao-wen;HUANG Guo-ying(Department of Clinical Immunology,Children’s Hospital,Fudan University,Shanghai 201102,China;Department of Pediatrics,Shanghai Songjiang District Central Hospital,Shanghai 201600,China;Department of Hematology and Oncology,Children’s Hospital,Fudan University,Shanghai 201102,China;Cardiovascular Center,Children’s Hospital,Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院临床免疫科,上海201102 [2]上海市松江区中心医院儿科,上海201600 [3]复旦大学附属儿科医院血液肿瘤科,上海201102 [4]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《复旦学报（医学版）》2022年第3期384-389,410,共7页Fudan University Journal of Medical Sciences

摘　　要：目的建立并完善上海市松江区复旦儿科医联体双向转诊体系,提高儿科转诊效率和质量。方法以复旦儿科医联体为平台,采用横断面调查分析2019年3月至2020年12月松江区中心医院儿科转诊至复旦大学附属儿科医院的患儿基本特征、转诊类型以及转诊至儿科各亚专科的病种情况。分析比较2020年与2019年转诊病例的病种分布特点、实际就诊数量、失访数量及有效转诊率。结果2019—2020年松江区中心医院儿科通过复旦儿科医联体平台共转诊306例患儿,年龄最小为出生后1小时,最大为14岁2个月,以1~6岁幼儿和大于6岁学龄期儿童为主,分别占36.9%和41.8%。依据患儿病情特点建立新生儿、危重症患儿、专科疾病三分类转诊流程,其中专科疾病转诊234例(76.5%)、危重症转诊44例(14.4%)、新生儿转诊28例(9.2%)。2020年与2019年转诊病例在性别、年龄分布、转诊类型方面无显著差异(P>0.05)。2019年转诊病例实际就诊101例,有效转诊率65.6%。改进转诊登记-随访-反馈一体化管理体系后,2020年转诊病例实际就诊122例,有效转诊率80.3%,较2019年有显著提升(P=0.004)。儿科转诊需求最多的亚专科前3位是:急诊内科、神经内科、感染科及儿外科(并列第三)。结论依据病情分类转诊可以为患儿提供最及时、最高效的优质医疗服务。通过“转诊登记-随访-反馈”一体化双向转诊体系显著提高了松江区中心医院儿科转诊率和质量。Objective To establish and improve the bi-direction referral system of Fudan Pediatric Medical Alliance in Songjiang District,Shanghai,and to improve the efficiency and quality of pediatric referral.Methods Based on the platform of Fudan Pediatric Medical Alliance,the basic characteristics,referral types and diseases of patients referred by Songjiang District Central Hospital to Children’s Hospital of Fudan University from Mar 2019 to Dec 2020 were analyzed through cross-sectional survey.We analyzed and compared the disease distribution characteristics of referral cases,numbers of actual visits and lost visits,and effective referral rate between 2020 and 2019.Results From 2019 to 2020,a total of 306 children were referred to Children’s Hospital.The minimum age of the children referred was 1 hour after birth,and the maximum age was 14 years and 2 months.Preschool children aged 1-6 and school-age children older than 6 were the main ones,accounting for 36.9%and 41.8%,respectively.According to the characteristics of patients'condition,a three-classified referral process of newborns,critically ill children and specialized diseases was established,including 234 cases of specialized diseases(76.5%),44 cases of critically ill diseases(14.4%)and 28 cases of newborns(9.2%).There was no significant difference in gender,age distribution and referral type between 2020 and 2019(P>0.05).In 2019,101 cases were actually referred,with an effective referral rate of 65.6%.After improving the integrated management system of referral registration,follow-up and feedback,122 cases were actually referred in 2020,with an effective referral rate of 80.3%,which was significantly higher than that in 2019(P=0.004).The top three sub specialties with the largest demand for pediatric referral were emergency internal medicine,neurology,infection department and pediatric surgery(tied for third).Conclusion The disease based classified referral system can provide the most timely and efficient high-quality medical services for children.Through th

关 键 词：儿科医联体 双向转诊 分级诊疗 

分 类 号：R197.1[医药卫生—卫生事业管理]