连续理论视角下医务人员双向转诊现状及提升路径OA

Objective Based on the continuity theory framework and the triadic reciprocal determinism,to construct an"Institution-Staff-Patient(I-S-P)"linkage model and explore the key factors influencing the willingness of medical personnel for two-way referral within a compact urban medical group,providing a theo-retical basis and optimization suggestions for better promoting hierarchical diagnosis and treatment.Methods A cross-sectional survey was conducted among in-service medical personnel from 8 community health service centers in the northern area of Minhang District using simple random sampling.The question-naire covered basic information,referral willingness,and influencing factors designed based on the I-S-P mod-el.Results A total of 450 questionnaires were distributed,and 355 valid questionnaires were returned,with an effective response rate of 78.89%.320(90.14%)medical personnel were willing to refer patients.Multivariate analysis showed that being administrative staff[odds ratio(OR)=0.079,95%confidence interval(95%CI)0.016-0.402],having referral experience(OR=7.335,95%CI 1.357-39.647),cognitive factors like"un-derstanding of referral policies"(OR=1.511,95%CI 1.098-2.079),agreement with support factors like"workload and capacity building"(OR=0.138,95%CI 0.040-0.474),agreement with comprehensive factors like"information platform construction"(OR=2.260,95%CI 1.015-5.033),agreement with hindering fac-tors like"medical insurance performance mechanism"(OR=8.187,95%CI 1.005-61.429),and agreement with comprehensive factors like"training guidance construction"(OR=2.440,95%CI 1.040-5.725)were signifi-cant influencing factors for medical personnel's willingness for two-way referral(P<0.05).Conclusion The willingness of medical personnel for two-way referral is high but is constrained by multiple factors such as in-stitutional setup and cognition.Strategies should be based on the"I-S-P"model,including improving incentive systems,optimizing information platforms,building MDT teams,and strengthening policy dissemination,to promote resource coordination in medical alliances and optimize hierarchical diagnosis and treatment.