Construction Of Transitional Care Model For Patients With Downward Referral In Tertiary Hospital Of Shandong Province

Objectives1.To investigate the current status and influencing factors of in-patient referral of inpatients in tertiary hospitals in Shandong Province,aiming to provide basis for the construction of transitional care model and the formulation of measures.2.To construct a transitional care model suitable for patients referred to the tertiary hospitals in Shandong Province,to provide a theoretical basis for promoting the continuity of care of patients in different medical institutions,improving the referral participation of nurses,and promoting the referral of patients.Method1.Using cross-sectional survey method to select patients with trauma orthopedics,cardiology,nephrology,gastrointestinal surgery and two gland surgery in a third-grade general hospital of Shandong Province from February to July in 2018.340 respondents participated in the study.2.Combining literature research,expert interviews and the results of the survey of the willingness of inpatients in the third-level hospitals to form a questionnaire for the continuous care model of patients in the third-level hospital of Shandong Province,through the Delphi method for the development of Shandong Province Three-level hospital nursing managers and information specialists who have continued nursing care conducted two rounds of expert consultations,using SPSS21.0 for data analysis,and finally establishing the data by calculating the authority level of experts,the degree of expert initiative,and the degree of coordination of expert opinions.Continuing care model for patients referred to the tertiary hospital in Shandong Province.Results1.48.82%of the patients agreed that after the condition was stable,the survey showed that 48.82%of the patients were in favour of referral from a higher hospital to a lower hospital after the condition was stable,meanwhile,32.06%of the patients opposed,and the higher-level hospital referred to the lower-level hospital;35.29%of the patients thought that the downward referral was very beneficial/The favorable diseases were treated in a timely and continuous manner;70.3%of the patients believed that institutions and personnel dedicated to referral should be established2.Among the patients surveyed,49.12%were willing to refer to the hospital.The main reason was that the hospital was close to home(86.83%)and the cost was lower(48.50%).The type of hospital that patients want to refer down is country-level hospitals(53.89%)and municipal-level second-level general hospitals(39.52%);50.88%of patients are unwilling to refer to lower,the main reason is that not being willing to refer for referral from tertiary hospitals to lower-level hospitals There is distrust of the lower level of medical technology(78.03%),poor environment,backward equipment(35.26%)and no need to refer(31.21%);if there are many preferential conditions for admission to lower-level hospitals(priority hospitalization,83.24%will be referred to the third-level hospitals;if the higher-level hospitals cooperate with the lower-level hospitals(establish a multi-disciplinary team of transitional care,train lower-level hospital nursing professionals and provide health care services,etc.),75.14%are willing to refer to the hospital3.The recovery rate of the two rounds of correspondence in this study was 83.3%and 92%respectively,and the ratio of opinion experts was 60%and 21.7%.The authoritative coefficients of the two rounds of experts were 0.88 and 0.87 respectively,and the familiarity was 0.87 and 0.84.After the inquiry,the coordination coefficients of the first-level,second-level and third-level items were 0.244,0.275,and 0.203,respectively.The expert opinions tend to be consistent.It is finally determined that the multidisciplinary team,nurse professional training,pre-patient referral intervention,and intelligence are established.The APP terminal follow-up,remote care consultation,5 primary items,10 second-level items,and 44 third-level items were transferred to the third-level hospital of Shandong Province for referral of patients with transitional care model.Conclusions1.Inpatients in the tertiary hospitals of Shandong Province have a higher willingness to refer to the hospital,and they will support the referral from the higher-level hospitals to the lower-level hospitals after the disease is stable.Distrusting the medical technology level,poor environment,and backward equipment of lower-level hospitals are the main factors affecting the referral of patients.If the superior hospital cooperates with the lower-level hospitals,establish a multi-disciplinary team of continuing care,train the nursing professionals of lower-level hospitals and provide health care.Service,etc.,the patient expressed willingness to refer to the doctor.2.Transitional care model of patients in the tertiary hospital of Shandong Province has higher authority,more consistent opinions and higher coordination.It can promote the continuous nursing mode of referral patients and promote the referral of patients.Provide evidence.