The implementation of bi-directional referrals may be affected directly by physicians since they play a crucial role in the process, but their performance in which will be facilitated by an orderly, efficient and interconnected referral system. So exploring the impact mechanism of informatization on physicians' performance in bi-directional referrals will greatly promote the implementation of such referrals and the development of hierarchical diagnosis and treatment.

To develop a qualitative model explaining the influence of informatization on physicians' intentions and behaviors regarding patient referrals, laying a foundation for relevant empirical research.

In April to October 2021, we performed a systematical review of studies about the influence of informatization on patient referrals collected from databases of CNKI, Wanfang Data, PubMed and Web of Science, then based on this and the framework of the Theory of Planned Behavior (TPB) , we developed a theoretical model explaining the impact of informatization on physicians' intentions and behaviors concerning patient referrals with self-defined latent variables and self-selected observed variables incorporated. After that, we used the theoretical model and the technology acceptance model to analyze patient referrals, then developed a corresponding business model.

The theoretical model contains six latent variables including behavior, intention, attitudes, subjective norm, perceived behavior control and informationization control-related factors, and observed variables for measuring each of the latent variables. The relationships between latent variables could be divided into correlation/covariance relationship and causality relationship. The business model could clearly reflect the influence of different levels of informatization on physicians' intention and behavior related to patient referrals. The business model indicates that the implementation of bi-directional referrals could be promoted with reduced difficulty only when information support sustains referral services delivered by hospitals in a collaborative way with patient information linked and shared, information system is further improved, and referral standards and information platforms are deeply integrated.

The development of this qualitative model may be a reference for constructing a quantitative model, and for the development of a bi-directional referral assessment system and the formulation of relevant policy documents in China, and may expand the applicable scope of the TPB.