目的:探讨医联体紧密合作协议中社区医院设立呼吸科专科病房的价值及在双向转诊中的应用.方法:设立南京市第一医院医联体全科医学中心呼吸科秦虹社区病房.选取建立病房后2016年3月1日～12月31日社区医院呼吸病房收治病人.重点了解社区病人收治来源、上下转诊率和转诊中存在的主要问题.结果:此期间共收治出院呼吸科病人230人,床位使用率64.6％.其中三甲医院病房下转31人,下转率63.3％.门诊下转34.78％;上转27人,均在第一时间转入三甲医院相关专科,上转率100％.单病种质控平均住院费用进入临床路径的社区获得性肺炎(CURB-65评分0～1分)人均费用较南京市第一医院呼吸科同期降低51.2％,COPD(无呼吸衰竭、肺心病)降低72.3％,两者比较差异均有统计学差意义(P＜0.01).结论:在社区医院建立专科病房能有效避免双向转诊中“转上容易转下难”的现象;大大降低患者的住院费用.“由点到面、全程管理、专人负责”的管理模式是分级诊疗及双向转诊制度的有益探索.%Objectives:To explore the value of setting up a ward specialized for respiratory in community health center and to apply its mode in dual referral.Methods:Patient hospitalized in specialized respiratory ward in Qinhong health community center which was the member of Nanjing the 1st hospital alliance from March 2016 to December 2016 were selected as the research objects.Data were focused on the source of patient,dual referral rate and problems during referral.Results:There are 230 patients discharged during the period.The bed occupied rate is 64.6％.31 patients were referred from hospitalization tertiary hospital with a rate of 63.3％ and 34.78％ was referred from outpatient department.27 patients were referred to tertiary hospital with a rate of 100％.Compared to Nanjing First Hospital,hospitalization expenses of CAP(CURB-65 0-1) and COPD got a great decrease with the rate of 51.2％ and 72.3％ respectively (P＜0.01)in community health service center.Conclusions:Setting up specialized ward in community health service center can effective avoid the problem of during referral and great decrease patient disease burden.It is a useful attempt on hierarchical medical system reform and implementing dual referral.
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