Impacting Factors to Implementation of the Two-way Referral System

Objective To explore and discuss contradictions and problems existing in the two-way referral system through analyzing the situation of patients' referral between Sichuan Provincial People's Hospital and 21 community health service centers in Chengdu,and propose measures and methods to further improve the two-way referral system.Methods Totally 3652 patients required referral from April 2010 to March 2011(2 635 patients from the hospital to community medical service centers and 1017 in a opposite direction) were selected.The reasons for referral and the factors for successful and unsuccessful referral were analyzed.The on-site interviews were conducted among doctors,department directors,and medical administrators from both the hospital and the centers.The talking topics included the design of bi-directional referral system,policy support from the government,current status of two-way referral and the main factors restricting the implementation of bi-directional referral system.Results Among the 2635 patients needed to have a referral from the hospital to centers(downward referral) for rehabilitation only 50 were successfully transferred,with a successful referral ratio of 52.7∶ 1.However,concurrently 1017 patients were transferred from the 21 centers to the hospital(upward referral).The ratio of upward referral to downward referral was 20.3∶ 1.There are a total of 1623 beds in all the 21 centers,however,the average utilization rate of beds was only 70.65%,as contrasted with that of 112.35% in the hospital.Majority of the interviewers believed that the factors impacting the implementation of two-way referral included un-smooth communication of medical information,no criteria and process of referral so far,shortage of mutual trust between the two referral parties,and non-full consideration of the two-way referral factors by the medical authorities in formulating the local health plan.Conclusion Although the two-way referral system has been implemented in Chengdu area,the rate of successful transfer is still lower,especially for the patients needing downward referral.