公立医院与托管医院双向转诊现状及实现机制

目的调查某大型公立医院与其托管民营医院双向转诊的运行现状,探讨目前双向转诊运行中存在的主要问题,研究双向转诊的实现机制。方法对实施双向转诊的公立医院与其托管民营医院医务人员各120名,以及150名普通市民进行问卷调查;收集2012年该公立医院及其托管民营医院的转诊记录。对调查所得数据进行统计分析。结果 2012年共转诊304人次,其中向上转诊208人次,主要以重型颅脑外伤及恶性肿瘤为主;向下转诊96人次,主要以确诊的慢性疾病为主。民营医院向上转诊患者的主要原因为无条件治疗、诊断与手术(选择率均超过50.0%);公立医院主要是在病情恶化,民营医院无力继续治疗及病因不明或需要进一步确诊的情况下接受转诊患者(选择率均超过80.0%);民营医院和公立医院工作人员对各向上转诊条件中"需要手术"的看法差异具有统计学意义(P<0.05);民营医院和公立医院工作人员对向下转诊条件中"诊断明确治疗方案完善的常见病"的看法差异具有统计学意义(P<0.05);民营医院和公立医院中有超过70%的工作人员对双向转诊了解;普通市民对目前的双向转诊运行现状不满意的原因主要是医疗机构为了各自利益不愿意转诊。结论该公立医院与其托管民营医院之间建立双向转诊条件,开展了双向转诊工作,并建立了相应的工作程序。

Operating Status and Realization Mechanism Related to Two Way Referral Between Large Public Hospital and Its Trusteeship Private Hospital

Objective To investigate the operating status related to two way referral between large public hospital and its trusteeship private hospital, and discuss the main problems in two way referral and study the reali- zation mechanism of two way referral. Methods Respective 120 medical staffs in public hospital and its trusteeship private hospital, 150 ordinary citizens were surveyed with questionnaires. Referral records were collected during 2012. Results 304 patients were transferred during 2012, in which 208 patients were upward referrals, mainly with severe craniocerebral traumas and malignant tumors; 96 patients were downward referrals and mainly with chronic diseases. The main reasons of private hospital to upward referral were unconditional treatment, diagnosis and operation （ the referral rate was more than 50.0% ） ; the referral rate was more than 80.0% for the public hospital to accept referrals when private hospital had no ability to cure or etiology unknown or need to be further confirmed ; there were significant difference in the view of operation need between the medical staffs in public hospital and its trusteeship private hospital（ P 〈 0.05 ） ; also there were significant difference in the view of diagnosed definitely treatment as chronic diseases between the medical staffs in public hospital and its trusteeship private hospital （ P 〈 0.05 ） ; more than 70.0% medical staffs knew the two way referral ; the main reason of ordinary citizens dis- satisfied two way referral medical was that institutions were not willing to referral for their respective benefits. Conclusion The conditions of two way referral have been established, the work of two way referral has been carried out in public hospital and its trusteeship private hospital.