医联体转诊系统优化与协同策略研究：基于排队网络

The establishment of medical associations has become an important carrier of hierarchical diagnosis and treatment in China, aiming to provide continuous and efficient medical services for patients and improve the overall efficiency of the medical system by integrating vertical medical resources and promoting two-way referral policy. But in the real-life scenarios, the inter-agency division of labor and collaboration degree of medical consortium is pretty low, patient mobility is quite poor, and there is a lack of collaborative triage mechanism and scientific referral strategy across healthcare institutions. According to the actual dilemma of the establishment of medical associations in China, and considering the public welfare goal of the entire healthcare service system, this project intends to carry out the research on the joint optimization and coordination strategy of the two-way referral system of medical associations, which is based on theories and methods like statistical analysis, queuing network, decision optimization, system simulation, etc. For a certain disease, firstly, the progressive relationship between patients' willingness and behaviors is studied through empirical research, and research on the scenario modeling analysis of "patients' voluntary and two-way referral" medical service system is conducted. Then, the queueing network theory will be used to construct the conceptual model of two-way referral of medical associations which considered patients' willingness, and the theoretical research on multi-scenario two-way referral joint optimization will be carried out based on the intelligent algorithm design. Finally, combined with the practice of a medical association, the multi-factor collaborative referral strategy of multiple agencies will be discussed from a systematic perspective. The study is of guiding significance for building a good cooperative relationship among medical consortium institutions and for promoting the construction of tightly-knit medical consortium.

医联体建设已成为我国推进分级诊疗的重要载体，旨在通过整合纵向医疗资源、推进双向转诊制度，为患者提供连续高效的诊疗服务，提高医疗服务系统的整体效能。但在实际运行中，医联体内不同机构间分工协作度低，患者流动性弱，缺乏跨机构间的协同分流机制与科学转诊策略。项目以中国医联体建设过程中的现实困境为基础，基于统计分析、排队网络、决策优化、系统仿真等理论与方法，以公益性为导向，开展医联体内不同机构间的双向转诊联动优化与协同策略研究。拟针对某一病种，首先通过实证研究分析患者就医意愿与行为间的递进关系，开展“患者自愿、双向转诊”医疗服务系统情景模拟；然后运用排队网络理论，构建考虑患者意愿的医联体双向转诊概念模型，并通过设计智能算法开展多情景双转联动优化理论研究；最后结合具体实践，从系统协同角度探讨多因素交互影响下的机构间协同转诊策略。研究对于提升医联体整体效能、推进紧密型医联体实践具有较强的理论指导意义。

研究依托我国多类型患者需求、多机构主体参与、多渠道服务供给、多层级资源配置、多节点供需交互影响的整合型医疗服务转诊系统复杂特征，针对医联体多路径、多节点转诊分流现实困境，采用统计预测、实证分析、排队网络、仿真优化等理论方法，从患者分流和资源配置视角出发，聚焦患者需求计划、医疗供给响应、医患供需协同优化三个关键问题，开展了医联体转诊系统优化与协同策略研究，探索构建数据驱动的复杂服务系统层级资源优化配置理论与方法，给出供需协同下的层级资源优化配置策略建议，以提升医联体转诊系统整体效能。研究针对医疗服务需求复杂波动特征，基于连续性服务节点间多特征融合患者流数据，开展了单节点患者流特征识别与需求预测分析，采用组合预测方法实现了患者需求预测，利于管理者精准制定节点间差异化需求计划与医疗资源周期性调度计划。针对大医院门诊患者基层分流难点，基于多节点、多阶段患者就医意愿与行为问卷调查，实证了医保制度与转诊路径双因素影响下的患者分流效应，提出完善“意愿-制度”融合的门诊精细化分流策略建议，验证了基于数据驱动的供给侧精准干预下系统供需协同分流调控效果。针对大医院慢病患者分流痛点，基于肾慢病患者需求与行为特征量表数据，运用主成分-聚类耦合方法，开展“患者需求识别-自我管理模式诊断-定制化服务干预”的结构化分析范式研究，为多元需求特征下医疗服务精准施策与分类供给匹配提供方法和策略建议。此外，研究还开展了医联体双向转诊和互联网慢病服务场景下的患者分流与资源配置仿真分析、以及基于医疗大数据的连续性服务需求与路径特征分析，计划从系统供需协同角度进一步探讨多因素交互影响下的多路径患者分流与层级资源优化配置策略。综上，研究理论结合实际，从供需协同视角，层次性、系统性开展了具有中国特色的数据驱动的复杂服务系统层级资源优化配置理论与方法研究，为推进整合型医疗服务体系建设提供了理论支持和策略建议。