Referral from secondary care and to aftercare in a tertiary care university hospital in Japan
Referral from secondary care and to aftercare in a tertiary care university hospital in Japan
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DOI：
10.1186/1472-6963-6-11
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发表时间：
2006-02-17
影响因子：
2.8
通讯作者：
Kouhei, A
中科院分区：
文献类型：
--
作者：
Toyabe, S;Kouhei, A
背景资料：在日本，国民保险制度覆盖所有公民，承诺人人都能免费获得医疗服务。在日本的医疗系统中，没有全科医生或守门人。方法：以儿科住院患者为例，使用地理信息系统（GIS），研究了从二级医院到三级医院的住院患者转诊模式以及在这种情况下的反向转诊。结果：结果表明，61.2%的患者是直接入院，不需转诊，82.8%的患者是经门诊或其他医院转诊。的住院病人被转介到他们入院的医院的门诊部。住院服务区的GIS分析显示，医院功能作为二级保健医院和三级保健医院。住在医院附近的病人往往直接入院，而住在离医院较远的病人往往利用医院作为三级保健提供者。与其他二级保健医院存在领土争端。为了估计转诊到善后护理的空间差异，我们分析了住院患者的空间分布，重点是他们的住院时间（LOS）。GIS分析显示，明显的病灶的患者与长LOS和低LOS.Conclusion：这些结果表明，在日本的大学医院的功能是非专业化的，从大学医院的转诊路线，以善后也不具备。
Background: In Japan, all citizens are covered by the national insurance system in which universal free access to healthcare services is promised to everybody. There are no general physicians or gatekeepers in the Japanese healthcare system.Methods: We studied the pattern of referral of inpatients from secondary care hospitals to a tertiary care university hospital and the reverse referral under the situations using a geographic information system (GIS), taking paediatric inpatients as an example.Results: The results showed that 61.2% of the patients were directly admitted to the hospital without referral from other hospitals or clinics and that 82.8% of the inpatients were referred to the outpatient department of the hospital to which they had been admitted. GIS analysis for the inpatients service area showed the hospital functions as both a secondary care hospital and tertiary care hospital. Patients who lived near the hospital tended to be admitted directly to the hospital, and patients who lived far from the hospital tended to utilize the hospital as a tertiary care provider. There were territorial disputes with other secondary care hospitals. To estimate spatial differences in referral to aftercare, we analyzed the spatial distribution of inpatients with focus on their length of hospital stay (LOS). GIS analysis revealed apparent foci of patients with long LOS and those with low LOS.Conclusion: These results suggest that the function of university hospital in Japan is unspecialized and that the referral route from the university hospital to aftercare is also unequipped.