What is it about?

Referral service is a patient-transferring process that is conducted between hospitals at different levels, such as specialty hospitals and comprehensive hospitals, or among specialty hospitals . The referral process in this study indicates patients with serious illness being transferred from primary-level hospitals to higher-level hospitals, which is a key process to share healthcare resources between different regions and is the core of the hierarchical medical system, addressing issues such as the provision of difficult medical services and expensive medical costs . In China’s medical reform process, improving referrals is a priority in the improvement of healthcare services, and efficiency of the referral process is also a focus of research in healthcare service management. Furthermore, the Chinese government has recognized the importance of the referral service and has made great efforts to establish and optimize the referral flow . However, the effect of these efforts has been unsatisfactory. however, there have been limited studies regarding patient satisfaction at different nodes during the referral process. In China, the delivery of healthcare services involves five independent referral nodes, namely, the transferring service at the primary-level hospital, referral appointment registration, claim of appointment number in the outpatient department, examination service, and admission service. Therefore, this study aimed at finding correlations between the overall satisfaction of patients during the referral service and patient satisfaction at each node of the referral process.

Featured Image

Why is it important?

The referral service is a significant component of healthcare reform in China, and the measurement of patient satisfaction with the referral service process will help to improve the quality of referral medical delivery. Furthermore, the referral service in China includes inter-institutional collaborations between hospitals at different levels and multi-nodes throughout the referral process. It is therefore necessary to identify the key nodes that affect patient satisfaction during the referral service process.


The key nodes affecting patient satisfaction were “transferring service at the primary-level hospital” and “admission service at the higher-level hospital”. This highlights the need to strengthen services in these areas. In summary, our research has implications in the following two aspects. For the service process, the improvement of patient satisfaction during the referral service is determined by the gatekeepers’ management of the referral system at the primary-level hospital and the allocation and management of bed resources at the higher-level hospital, which is the result of joint efforts by hospitals at the different levels. Regarding the referral system, the findings can provide recommendations for practical medical reforms. First, hospitals at the different levels should clarify roles and perform their individual functions to foster cooperation and ensure the efficient execution of the referral service process. Second, hospitals should focus on the improvement of service at the nodes of referral appointment registration, claim of appointment number in the outpatient department, and examination service to promote patient satisfaction in details.

shuzhen zhao

Read the Original

This page is a summary of: Key nodes affecting patient satisfaction in a cross-regional referral service process: an empirical analysis study in Sichuan, BMC Health Services Research, November 2018, Springer Science + Business Media,
DOI: 10.1186/s12913-018-3460-8.
You can read the full text:



The following have contributed to this page