CAJ | 학술논문

目的了解三级医院与社区医院住院患者双向转诊中存在的问题.方法选取于2009-02-01-2009-08-31在北京朝阳医院住院、病情稳定但仍需继续住院观察、向社区医院下转者,以及在六里屯社区卫生服务中心住院、病情变化需要向三级医院上转者为研究对象.重点了解上、下转诊率和转诊中存在的主要问题.双向转诊工作组由北京朝阳医院和六里屯社区卫生服务中心指定人员组成,负责双向转诊的具体业务衔接.结果此期间北京朝阳医院符合下转住院者186人次,仅62人下转至社区医院,下转率为33.3%;未能下转的主要原因依次为社区医院药物受到限制尤其是关键药物不能报销81人(65.3%)、下转定点对口社区医院没有病床27人(21.8%)、对社区医疗条件和水平质疑16人(12.9%).六里屯社区医院符合上转住院者49人次,全部上转,上转率为100.0%;值得注意的是其中25例患者(51.0%)上转的原因是社区医院药物不全,其次为患者或家属对社区医疗水平质疑而主动提出上转要求.结论住院患者双向转诊呈现转上容易转下难的现象,主要原因是社区医院的药物受到限制尤其是关键性药物不予报销,其次为定点对口社区医院没有病床及患者对社区医院医疗条件和技术水平的质疑.
목적 료해삼급의원여사구의원주원환자쌍향전진중존재적문제.방법 선취우2009-02-01-2009-08-31재북경조양의원주원、병정은정단잉수계속주원관찰、향사구의원하전자,이급재륙리둔사구위생복무중심주원、병정변화수요향삼급의원상전자위연구대상.중점료해상、하전진솔화전진중존재적주요문제.쌍향전진공작조유북경조양의원화륙리둔사구위생복무중심지정인원조성,부책쌍향전진적구체업무함접.결과 차기간북경조양의원부합하전주원자186인차,부62인하전지사구의원,하전솔위33.3%;미능하전적주요원인의차위사구의원약물수도한제우기시관건약물불능보소81인(65.3%)、하전정점대구사구의원몰유병상27인(21.8%)、대사구의료조건화수평질의16인(12.9%).륙리둔사구의원부합상전주원자49인차,전부상전,상전솔위100.0%;치득주의적시기중25례환자(51.0%)상전적원인시사구의원약물불전,기차위환자혹가속대사구의료수평질의이주동제출상전요구.결론 주원환자쌍향전진정현전상용역전하난적현상,주요원인시사구의원적약물수도한제우기시관건성약물불여보소,기차위정점대구사구의원몰유병상급환자대사구의원의료조건화기술수평적질의.
Objective To investigate the problems in two-way referral path between the third level hospital and community hospital for inpatients.Methods The inpatients needed to be referral from Beijing Chaoyang hospital to Liulitun community hospital or oppositely were enrolled from February 1 to August 31,2009.The rates of downward referral and upward referral,and the problem during the referral were investigated.The members of the referral working group specially appointed form Beijing Chaoyang hospital,and responsible and Liulitun community hospital.Results Only 62 (33.3%) of 186 inpatients necessary to be downward transferred were successfully done during the period.Among the unsuccessfully downward transferred inpatients,there were 81(65.3%) whose reason was problem of reimbursement of drug expense,especially some key drugs;27 (21.8%) whose reason was lack of sickbed in the corresponding community hospital;16 (12.9%) whose reason was their doubt to the technical level and medical conditions of community hospitals.However,for all the 49 inpatients necessary to be upward transferred in Liulitun community hospitals the referral was smoothly done.Noticeably,the reasons of upward referral for 25 patients (51.0%) were due to incomplete kinds of drugs,or doubtfulness of the patients or their family members to the medical level of the community hospitals.Conclusion The work is easy for upward referral of the inpatients,but difficult for downward referral.This is mainly due to problem of reimbursement of drug expense,especially some key drugs;next due to short supply of sickbeds in the corresponding community hospitals,and doubtfulness of the medical conditions and technical level by patients to the community hospitals.