关键词: 家庭医生签约服务, 社区居民, 预约转诊, 分级诊疗

Abstract: Background　Transferring contracted residents with a disease that cannot treated in the community health center to a higher level hospital via an appointment made in advance，is an important contracted task for family doctors，and is also a basis of implementing the hierarchical medical policies.Objective　To investigate the implementation of referral appointments in contracted residents，providing a theoretical basis for further improvement and popularization of the services.Methods　This study was conducted in 240 contracted patients from Minhang District Pujin Community Health Center（MDPCHC），including 120 with an experience of ever being transferred to a higher level hospital from MDPCHC after making an appointment in advance（appointment group） during January to June 2019，and 120 randomly selected cases with the record of seeking healthcare in a higher level hospital during the same period but without making an appointment（non-appointment group）.Basic general data and appointed referral data of the appointment group were collected from Shanghai Family Doctor Referral Appointment Platform.A telephone questionnaire survey based on hierarchical diagnosis and treatment and family doctor services was conducted in both groups.The influence of implementing referral appointments on relevant business development was analyzed.Results　The mean age of the appointment group was（65.4±8.7） years old，most of whom were elderly people.The average number of referral appointments was（1.5±1.0），and the average appointment period was（13.2±11.4） days.The hospital with the highest number of appointments was Southern Division of Renji Hospital，accounting for 70.1%（124/177） of the total appointment.The department with the highest number of appointments was digestive department（22.0%，39/177）.The survey showed that both groups' patients showed significant differences in the awareness rates of names of their contracted family doctors，and specific contents of contracted family doctors services，level of satisfaction with contracted family doctors services，community health services，and with the services delivered by the local general hospitals（P<0.05）.Conclusion　The implementation of the policies concerning referral appointments by family doctors has facilitated contracted residents to access to the registration of higher level hospitals，increased their awareness of and satisfaction with relevant medical services，and is conducive to the development of hierarchical diagnosis and treatment.To further take the advantages of making appointments with specialists working at higher level hospitals by the family doctor，it is suggested to strengthen the propaganda and use frequency of the referral appointment platform，ensure the implementation of family doctor services by the cooperative institutions of the medical consortium，increase the number of specialist appointments of the department with high-frequency referral appointments，and reduce the referral waiting time of the patients as far as possible.

Key words: Contracted family doctor services, Community residents, Appointment referral, Hierarchical diagnosis and treatment