中国城乡基层医生转诊行为及其影响因素研究

目的：分析中国城乡基层医生的转诊行为及其影响因素。方法：利用2016年中国基层医疗服务能力及质量综合评价调查项目横断面数据，以社区卫生服务中心和乡镇卫生院两类机构的医生作为研究对象。通过三水平随机截距Logistic回归模型分析影响医生转诊行为的主要因素。结果：被调查医生中有84.01%曾向上级机构转诊过患者，38.72%曾接受过上级机构下转的患者。乡镇卫生院医生向上转诊患者的行为比社区卫生服务中心医生更容易发生（OR=2.24，P<0.001）。男性、有执业资格、可以常规使用电子信息系统对基层医生参与双向转诊有正向影响。高学历、高职称对社区卫生服务中心医生，高龄对乡镇卫生院医生参与双向转诊有促进作用。基层与二级机构住院报销比例差距增加以及乡镇卫生院万元以上设备数量增加都对医生接受上级机构转诊患者有促进作用。医生转诊行为的变异归属于医生个体的部分和归属于机构水平的部分分别为26.9%~33.3%和48.0%~59.9%。结论：实现双向转诊的关键在于提高基层医疗卫生机构的服务能力和基层的人力水平。

Analysis on the primary care doctor's referral behavior and its influencing factors in urban and rural areas of China

Objectives:To study the referral behavior and explore the influencing factors among primary care doctors in urban and rural areas of China. Methods:Data comes from a nationwide cross-sectional survey of primary health care in China:the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey in 2016. The doctors from community health centers(CHCs)and township health centers (THCs) were selected as research objects. Three-level random-intercept binomial logit model was used to explore the influencing factors. Results:84.01% of the doctors referred patients upward and 38.72% of the doctors interviewed patients who had been transferred from the upper level institutions. Doctors in township health centers referred patients upward more easily than those in community health centers (OR=2.24,p<0.001). Male,practice qualification,and using electronic information system regularly are factors could facilitate doctors'' participation in two-way referral system. High education and high-level titles are contributing factors for doctors in CHCs,and advanced age plays a catalytic role for doctors in THCs to participate in two-way referrals. The variations of doctors'' referral behaviors attributed to the individuals and institutions are 26.9%~33.3% and 48.0%~59.9%,respectively. Conclusions:The key to achieving the two-way referral system is to improve the service capabilities of primary health care institutions and health workforce in primary health care system.