Objective This study aims to systematically analyze the current status of downward referral among rehabilitation physicians in secondary and tertiary hospitals and investigate its influencing factors.By identifying key bottlenecks in the rehabilitation referral process,this study seeks to provide recommendations for optimizing the hierarchical medical system. Methods A multi-stage stratified cluster sampling method was employed to recruit 203 rehabilitation physicians from 33 secondary and tertiary medical institutions across 18 cities in eastern,central,and western China.Data were collected via self-administered online questionnaires,covering demographic characteristics,professional background,and hierarchical medical system-related factors.An ordered multinomial logistic regression model was used to analyze the factors influencing rehabilitation physicians' downward referral behavior. Results After controlling for confounding factors,the nature of the institution in which the doctor worked (OR=0.475, 95%CI=0.245-0.923, P=0.028),downward referral based on the doctor's own clinical experience (OR=0.423, 95%CI=0.217-0.824, P=0.011),the number of outpatient (emergency) visits received in the last week (OR=1.006, 95%CI=1.001-1.011, P=0.018),knowledge of two-way referrals (OR=1.646, 95%CI=1.042-2.601, P=0.033),confidence in correctly judging the timing of patient referrals (OR=1.556, 95%CI=1.013-2.391, P=0.043),and willingness to refer patients downward (OR=1.901, 95%CI=1.366-2.646, P<0.001) were all independent factors influencing rehabilitation physicians' downward referral behavior. Conclusions Rehabilitation physicians' downward referral behavior is influenced by institutional nature,clinical experience,patient volume,referral system awareness,confidence in referral decisions,and referral intention.To enhance referral efficiency and promote the balanced development of rehabilitation services within the hierarchical medical system,this paper proposes the following recommendations:improving bidirectional referral policies,optimizing medical insurance payment structures,strengthening rehabilitation physician training,and encouraging public-private collaboration. 目的 系统分析二、三级医院康复医生向下转诊行为的现状,并探究其影响因素,以揭示当前康复转诊环节的关键瓶颈,为完善分级诊疗体系中的康复转诊流程提供策略建议。方法 采用多阶段分层整群抽样方法,从我国东、中、西部18个城市的33家二、三级医疗机构中抽取203名康复医生作为研究对象。通过网络自填问卷的方式收集数据,问卷内容包括医生的社会人口学特征、职业概况及分级诊疗相关情况。采用有序多分类Logistic回归模型分析康复医生向下转诊行为的影响因素。结果 在控制其他混杂因素后,公立机构的医生(OR=0.475,95%CI=0.245~0.923,P=0.028)、根据本人临床经验办理下转(OR=0.423,95%CI=0.217~0.824,P=0.011)、上周门(急)诊接诊人次越多(OR=1.006,95%CI=1.001~1.011,P=0.018)、对双向转诊的了解程度越高(OR=1.646,95%CI=1.042~2.601,P=0.033)、正确判断患者转诊时机的信心越强(OR=1.556,95%CI=1.013~2.391,P=0.043)、向下转诊患者的意愿越强(OR=1.901,95%CI=1.366~2.646,P<0.001),康复医生向下转诊患者的可能性越高。结论 康复医生的下转行为受医院性质、临床经验、接诊量、转诊认知、判断信心及转诊意愿的影响。建议通过完善双向转诊政策、优化医保支付、加强康复医生培训、鼓励公私协作,提升转诊便利性,促进康复服务的均衡化和分级诊疗体系落地。.
使用 AI 将内容摘要翻译为中文，便于快速阅读
使用 AI 分析这篇文章的核心发现、关键要点和深度见解
由 DeepSeek AI 提供分析 · 首次使用需配置 API Key
arXiv · 2026-01-22
arXiv · 2026-04-07
arXiv · 2026-04-07