我国分级诊疗研究热点的文献计量学分析

背景　分级诊疗是实现医疗机构社会分工、解决人民群众“看病难”问题的重要举措。了解其研究热点及趋势，有助于分级诊疗的实施。目的　分析我国分级诊疗领域研究热点及趋势，为其可持续性研究提供参考。方法　在中国知网（CNKI）中检索分级诊疗相关文献1 162篇，导入文献题录信息统计分析工具SATI 3.2，统计文献发表年份、来源期刊，并生成关键词共词矩阵，将共词矩阵分别导入Ucinet 6.0的Netdraw程序和SPSS 19.0软件中绘制共现网络图谱和聚类树图。结果　我国分级诊疗相关研究始于1993年，文献量逐年增多，大致可分为奠基期（1993—2008年）、缓慢增长期（2009—2014年）、快速增长期（2015年以后）；载文量排在前3位的期刊为《中国全科医学》（277篇，23.84%）、《中国医院管理》（120篇，10.33%）、《中国卫生经济》（99篇，8.52%）；频次排在前3位的关键词为分级诊疗（424次）、双向转诊（249次）、社区卫生服务（164次）。双向转诊处于共现网络图谱核心位置，是分级诊疗最重要节点；就医行为、对口支援、医养结合、医疗服务价格、优质护理、信息化等处于图谱边缘，是分级诊疗领域的研究趋势。通过聚类树图将高频关键词归纳为5个主题类团：以医疗联合体为载体的分级诊疗影响因素研究，基层首诊认知及满意度研究，医疗资源整合及优化配置研究，以全科医生为主的健康管理服务研究，慢性病患者的转诊、就医行为及医疗费用研究。结论　综合研究热点及趋势，我国分级诊疗相关研究主要为：以基层首诊促进分级诊疗实施，以高血压、糖尿病等慢性病患者的转诊，以全科医生为主的健康管理服务，以医疗联合体为载体促进分级诊疗的研究。

Bibliometric Analysis of the Research Hotspots of Hierarchical Diagnosis and Treatment in China

Background Hierarchical diagnosis and treatment is an important measure to realize the social division of labor in medical institutions and to solve the problem of "difficulties to access medical services".Comprehending its research hotspots and trends is helpful for the implementation of hierarchical diagnosis and treatment.Objective To identify current research hotspots and trends of hierarchical diagnosis and treatment in China,to provide a reference for sustainable research of this field.Methods 1 162 articles about hierarchical diagnosis and treatment were searched from CNKI database.SATI 3.2 was used to input the publication year,and source journal of the articles,and generated keywords co-occurrence matrix.Netdraw,a program within the Ucinet 6.0 suite,and SPSS 19.0 were applied to draw the co-occurrence network diagram and tree diagram showing hierarchical clustering using the keywords co-occurrence matrix.Results The research on hierarchical diagnosis and treatment in China started in 1993,and the amount of studies showed an increasing trend year by year.Its development can be roughly divided into foundation phase(1993-2008),slow growth phase(2009-2014) and rapid growth phase(2015-). The top three journals owning greatest amount of studies are Chinese General Practice(277 articles,23.84%),Chinese Hospital Management(120 articles,10.33%) and Chinese Health Economics(99 articles,8.52%).The top three high-frequency key words were hierarchical diagnosis and treatment(424 times),two-way referral(249 times),community health services (164 times).The two-way referral was at the core of the co-network diagram,and is the most important link for hierarchical diagnosis and treatment.Healthcare-seeking behaviors,counterpart support,integrated medical and nursing care,medical service prices,high quality care and informatization were on the edge of the map,which are the research trends.According to the tree diagram,the high-frequency key words were summarized into five thematic clusters:influencing factors of hierarchical diagnosis and treatment within the regional medical consortium,perception of and satisfaction with first contact services in primary care,integration and optimal allocation of medical resources,health management services delivered mainly by general practitioners,and referrals,healthcare-seeking behaviors and medical costs in patients with chronic diseases.Conclusion Available studies about hierarchical diagnosis and treatment in China are summarized as follows on the basis of analyzing of the research hotspots and trends:promoting the implementation of hierarchical diagnosis and treatment via carrying out first contact services in primary care,and using the platform of regional medical consortium,referral services for hypertension,diabetes and other chronic diseases,and health management services provided mainly by general practitioners.