Wilkin D, Metcalfe D H, Marinker M
Community Med. 1989 Feb;11(1):65-70. doi: 10.1093/oxfordjournals.pubmed.a042448.
Research shows consistently wide variations in all aspects of general medical practice. Extreme variations in rates of referral to hospital have recently been highlighted, but remain largely unexplained. New information systems now make it possible to identify GPs with very high or very low rates of referral so that their behaviour can be reviewed. Before using this information politicians, managers and doctors should give careful thought to what it means and its limitations. The rate of referral provides no indication of the appropriateness of referrals. Any intervention designed to improve the referral mechanism should aim to increase the proportion of people who are appropriately referred to hospital and to reduce the proportion who are inappropriately referred. This is unlikely to be achieved by focusing attention on GPs with high or low rates regardless of how they are made up.
研究表明，普通医疗实践的各个方面一直存在很大差异。最近，转诊至医院的比率存在极大差异的情况已受到关注，但在很大程度上仍无法解释。新的信息系统现在使识别转诊率极高或极低的全科医生成为可能，以便对他们的行为进行审查。在使用这些信息之前，政治家、管理人员和医生应仔细考虑其含义及其局限性。转诊率并不能表明转诊的适当性。任何旨在改善转诊机制的干预措施都应旨在增加被适当转诊至医院的人数比例，并减少被不适当转诊的人数比例。仅仅关注转诊率高或低的全科医生，无论其构成如何，都不太可能实现这一目标。
