國內某醫學中心與週邊醫療院所雙向轉診（檢）合作模式研究

A Study on the Cooperative Pattern of Two-Way Referral between Domestic Medical Center & Medical Care Institutions in the Neighboring Region

目的：旨在探討醫院與醫院週邊基層診所之不同執業群體醫師的轉診 （檢）利用概況，同時，進一步探究二者問封建立雙向轉診（檢）合作之意願 與相關影響因素。 方法：本研究採自擬結構式問卷設計，探討醫師特性、機構特性及轉診 （檢）利用經驗與有無意願建立雙向轉診（檢）合作之關係o 針對個案醫院編 制內主治醫師（共218 位）及該院九十四年七至九月份百分之八十以上門診病 人來源與轉診（檢）機構所轄行政區域內之基層診所執業登記負責醫師（共 1 ， 812 位） ，總計2 ， 030 位進行調查；經九十四年九月廿一日至十月廿一日調 查，乃回收有效問卷365 份（1 7.9%） 並以對數迴歸進行分析。 結果： （一）不論是個案醫院或該院週邊基層診所醫師皆對雙向轉診 （檢）抱持著高度合作意願'分別為： 94.83% ' 83.13% ；在合作項目方面，二 者皆以轉診（醫院9 l. 82% '診所95.94% ）、轉檢（醫院46.36% '診所4 l. 12% ） 或代檢（醫院3 l. 82% '診所22.34% ）為較具共識之合作模式； （二）個案醫 院雙向轉診（檢）合作目標群體，可選擇年齡較輕之間業醫師（三十六至四 十五歲間） ，執業地點位在內湖區、南港區、汐止市、中正區、大安區，診間 可上網，月均門診量介於501-1 ， 000人次，曾有轉診（檢）經驗，及考量病情 因素轉診（檢）之診所； （三）為增進雙向轉診（檢）合作關係，二者認為應 先採行的配套行政措施為：l.主動回覆轉診（檢）報告並會指示病人回原診所 繼續處理； 2. 簡化轉診（檢）手續； 3. 侵先處理被轉診（檢）的病人； 4. 定期 提供個案醫院門診時刻表或相關訊息資料等。 建議： （一）個案醫院未來可依據醫院本身及社區特色資源來選擇研究 中有意願合作之醫師群體，以作進一步之合作規劃討論； （二）為促進雙向轉診（檢）合作模式建立，建議應提供完善的管理機制或誘因來增加合作成功 機會，例如：個案醫院可開發轉診轉檢資訊系統，以簡化轉診作業流程、強 化醫院與合作院所問之溝通，使轉診作業能順利進行。

Objective: The study is performed on how referral is carried out by different groups of doctors in different fields of practices in hospitals and clinics surrounding those as well as additionally, there is a further discussion over the willingness of building cooperative systems of two-way referral between them and what key factors related to it influence them. Method: The structured questionnaire has been designed by three authors and centers on correlation among the characters of doctors and institutions, experiences of referral and willingness to build thecooperative systems of two-way referral. We have issued 2030 pieces of questionnaire to 218 attending doctors officially employed by the studied hospital in our case, 80% of patients receiving treatment in the clinics from July to September, 2005 and the doctors with practice registration of doctor in the clinics located within the district of that hospital. The latter two are distributed 1812 pieces. The survey proceeded from September 21st to October 21st, 2005. We recollect 365 effective pieces of questionnaires, accounting for 17.9% of those issued and analyze those samples with logistic regression. Results: A. The analyzed results are respectively 94.83% and 83.13% showing that doctors treating patients in hospitals of our study case or clinic surrounding it all hold significantly cooperative attitudes toward two-way referral. Next are the items they desire to cooperate on showing that in the respect of referral, the hospital accounts for 91.82% and clinics account for 95.94%. In the respect of transferring patients to other medical care institutions for examination, the hospital accounts for 46.36% and clinics account for 41.12%. In the respect of carrying out examination for another hospital or clinic, the previous accounts for 31.82% and clinics account for 22.34%. They reach a consensus on those three cooperative patterns. B. The hospital in our survey can cooperate with target groups having some characteristics depicted below. First, doctors are between 36 and 45 years old. Second, they practice medicine in Neihu District, Nangang District, Sijhih City, Jhongjheng District and Da-an District. Third, the patients and their relatives or friends can surf Internet in clinic. Fourth, there are between 501 and 1000 patients receiving treatment in every month. Fifth, they have experiences of referral or refer patients due to their conditions. C. To strengthen their cooperation, they think that some necessary administrative measures should be taken. First, they can reply the reports of referral automatically and request patients to receive treatment in the referring hospital or clinics. Second, the procedures of referral must be simplified. Third, treating the referred patients is given priority. The clinics schedule and information related to the hospital in our survey should be regularly offered. Suggestions: A. The studied hospital can cooperate with doctors who are willing to build the cooperative systems of referral and make a further formulation and discussion based on the distinctions and resources of hospital and communities. B. In order to promote the establishment of cooperative systems of tow-way referral, we suggest that they can make cooperation possible by providing good mechanism of management and incentives. For instance, the studied hospital can develop the referral information system in order to simplify the procedures of referral, strengthen communication between hospitals and cooperative medical care institutions and make affairs of referral work well.