Abstract
BACKGROUND: Stratified health care systems are used globally to optimize medical resource allocation and enhance patient care experiences. Although successfully implemented in countries like the United Kingdom, Australia, and Canada, China's introduction of stratified health care in 2015 has achieved progress in disease management but still faces challenges due to the lack of a comprehensive referral evaluation system and patients' preference for higher-tier medical institutions. OBJECTIVE: This study aims to investigate the factors influencing Chinese rehabilitation physicians' referral decisions for outpatient rehabilitation patients. The findings may provide empirical evidence for developing stratified rehabilitation triage tools and constructing a referral evaluation system in China. METHODS: This cross-sectional study, conducted from September 2023 to January 2024, examined the patient factors (diagnosis, functional impairments, disease status, condition stability, duration of illness, and functional status measured via the Longshi Scale) impacting physicians' referral decisions for outpatient rehabilitation services in China. Data were collected through convenient stratified sampling from physicians and outpatient rehabilitation patients across 12 medical institutions in 5 cities in China. RESULTS: A total of 131 rehabilitation physicians conducted diversion assessments for 1984 outpatient rehabilitation patients in this study. In total, 45.5% (902/1984) of outpatient rehabilitation patients were considered by physicians to be referred to rehabilitation outpatient clinics, 19% (376/1984) to primary health care institutions, 20.4% (405/1984) to secondary institutions, and 15.2% (301/1984) to tertiary institutions. Single-factor analysis indicated that age, disease, functional impairment, disease control, disease stability, and Longshi Scale results were significantly associated with physicians' decisions regarding the referral institutions for outpatient rehabilitation patients. Logistic regression analysis showed that neurological disorders (odds ratio [OR] 1.88, 95% CI 1.02-3.43; P=.04), cardiopulmonary diseases (OR 2.91, 95% CI 1.07-7.93; P=.04), geriatric conditions (OR 0.40, 95% CI 0.23-0.68; P<.001), disease control (OR 0.23, 95% CI 0.13-0.34; P<.001), and Longshi Scale results for the bedridden (OR 0.10, 95% CI 0.14-0.34; P<.001), and domestic groups (OR 0.24, 95% CI 0.14-0.34; P<.001) as independent factors for referrals to tertiary versus primary institutions. Orthopedic diseases (OR 3.27, 95% CI 1.89-5.67; P<.001), geriatric conditions (OR 0.58, 95% CI 0.33-1.87; P=.009), cognitive impairments (OR 1.98, 95% CI 1.17-3.36; P=.01), multiple impairments (OR 0.35, 95% CI 0.18-0.70; P=.002), and disease control (OR 0.26, 95% CI 0.15-0.37; P<.001) were key factors for tertiary versus secondary referrals. CONCLUSIONS: In advancing China's rehabilitation triage in the future, gaining a deep understanding of the key factors influencing physicians' decisions and quickly establishing a referral evaluation system will facilitate the accurate diversion of outpatient rehabilitation patients, enabling them to receive convenient, high-quality, and low-cost medical services. In addition, it will assist the government in reasonably and effectively allocating medical resources, thus achieving the optimization and coordination of the health care system.