分层级入院视角下医联体系统转诊策略与协同机制研究

医联体建设是分级医疗改革的重要途径和分级诊疗制度落实的有效载体。但在实际推行中，医联体系统内部患者无序流动、缺乏科学合理转诊策略与有效分工协作机制，医联体政策未能达到预期效果。本课题立足医联体运行现状，以大型综合医院作为突破点，聚焦患者入院需求，运用机器学习、多准则决策、排队博弈理论、系统仿真等理论方法，深入开展跨区域背景下以大型综合医院为核心的医联体转诊策略与协同机制研究。首先从数据驱动和多准则决策方法两个维度，依次展开患者入院优先级决策研究，为医院处理不同场景下患者分级分类提供技术支持。然后，运用排队理论构建医联体转诊系统理论模型，分别从系统协调性与合作的稳定性出发，开展医联体系统转诊决策和激励机制设计研究。最后，通过系统模拟仿真探讨多优化目标场景和多因素交互作用的医联体服务系统协同策略与效果研究。本研究为政府制定医联体服务系统转诊策略提供科学理论依据和决策支持。

The construction of the medical consortium is an important way for hierarchical medical reform and an effective carrier for the implementation of the hierarchical diagnosis and treatment system. However, the disorderly flow of patients within the medical consortium system, the lack of scientific and reasonable referral strategies and an effective division of labor and coordination mechanism, the medical consortium policy failed to achieve the expected results.This project is based on the status of the medical consortium, with large general hospitals as a breakthrough point, focusing on the needs of patients for admission, using machine learning, multi-criteria decision-making, queuing theory, game theory, and simulation methods to deeply study medical consortium referral strategies and coordination mechanisms with large general hospitals as the core in a cross-regional context. Firstly, use data-driven and multi-criteria decision-making methods to successively carry out research on decision-making of patient admission priority, and provide technical support for hospitals to handle patient classification in different scenarios. Then, the queuing theory is used to construct the theoretical model of the medical consortium referral system, starting from the coordination of the system and the stability of cooperation, to carry out the research on medical consortium system referral decision-making and incentive mechanism design. Finally, through system simulation, the collaborative strategy and effect evaluation of the medical consortium service system with multiple optimization target scenarios and multi-factor interaction are discussed. This research provides scientific theoretical basis and decision support for the government to formulate the referral strategy of the medical consortium service system.