Crombie D L, Fleming D M
Health Trends. 1988 May;20(2):53-6.
The emergency and outpatient referral rates of practices taking part in the 2nd and 3rd National Morbidity Studies (NMS-2, NMS-3) were studied. Variation in referral rate between individual practices was contrasted with variation between different practice and patient sub-groups. Variability in referral rates between practices to outpatient departments was shown greatly to exceed variability of these rates associated with different practice locations (urban/rural), and between sexes, age-groups or social groups of patients. A similar contrast was seen when exploring rates for inpatient referrals (with exception made for rates in patients aged 75+). There were strong correlations present between individual practice referral activity in the first two years of NMS 2 (R = 0.72, n = 43, P = less than .001), and between NMS-2 and NMS-3 for those practices which participated in both studies (R = 0.80, n = 18, P = less than .001), indicating a high degree of consistency of referral behaviour. In the 3rd study total referrals from general practice were 10.6 per 100 population compared with 20.7 per 100 reported in hospital statistics. Direct access to Accident and Emergency (A and E) Departments and internal hospital referrals between specialist departments account for the bulk of the difference. The cost implications of variability in referral rates among practitioners are considerable. More data about referral are required.
对参与第二次和第三次国家发病率研究（NMS - 2、NMS - 3）的医疗机构的急诊和门诊转诊率进行了研究。将个体医疗机构之间转诊率的差异与不同医疗机构及患者亚组之间的差异进行了对比。结果显示，各医疗机构向门诊科室的转诊率差异大大超过了与不同医疗机构所在地（城市/农村）以及患者性别、年龄组或社会群体相关的这些比率的差异。在探究住院转诊率时也出现了类似的对比情况（75岁及以上患者的比率除外）。在NMS 2的前两年，个体医疗机构的转诊活动之间存在很强的相关性（R = 0.72，n = 43，P < 0.001），对于参与两项研究的医疗机构，NMS - 2和NMS - 3之间也存在很强的相关性（R = 0.80，n = 18，P < 0.001），这表明转诊行为具有高度的一致性。在第三次研究中，全科医疗的总转诊率为每100人中有10.6例，而医院统计报告的为每100人中有20.7例。直接前往事故与急救（A&E）科室以及医院各专科之间的内部转诊占了差异的大部分。从业者之间转诊率的差异所带来的成本影响相当大。需要更多关于转诊的数据。
