研究目的：
基于计划行为理论构建医疗机构间信息互联互通对医生双向转诊意向影响的理论分析框架，分析信息互联互通对医生双向转诊意向的影响机制，为进一步促进互联互通、完善双向转诊信息系统建设提供依据。
研究内容：
1.构建信息互联互通对医生双向转诊意向影响的理论框架；
2.临床医生对医疗机构间信息互联互通的感知信念及双向转诊意向分析；
3.信息互联互通对双向转诊意向影响的单因素分析；
4.构建信息互联互通对临床医生双向转诊意向影响的定量模型。 
研究方法：
本研究选取北京、江苏、浙江和山东地区进行横断面调查，共将其中的14家医院纳入调查范围。基于计划行为理论构建信息互联互通对医生双向转诊意向及行为影响的理论分析框架。通过百分比、均值、标准差对资料进行描述性分析。使用²检验分析信息互联互通对知觉行为控制的影响。在分别控制不同个体特征、转诊态度、主观规范、知觉行为控制的情况下，分析信息互联互通对临床医生双向转诊意向的影响。运用pearson相关分析探索信息互联互通情况、意向、态度、主观规范、知觉行为控制之间的相关关系。最后利用结构方程模型（SEM）进行多因素分析并构建定量模型。
研究结果：
1.本次被调查的625名临床医生中，认为当前信息系统联通程度差的医生有417人，占比66.7%；认为当前信息系统联通程度好的有208人，占比为33.3%。
2.在控制临床医生双向转诊态度的情况下，临床医生对双向转诊有积极态度的时候，不同信息系统联通程度对双向转诊意向的影响均有统计学意义（p<0.001）;但医生对双向转诊本身未抱有积极的态度时，互联互通程度与双向转诊意向差别无统计学意义（p>0.05）。在控制临床医生双向转诊主观规范的情况下，临床医生感受到周围重要人群对其有进行双向转诊的期望时，不同信息互联互通程度对双向转诊意向的影响均有统计学意义（p<0.001）；临床医生感受到周围重要人群对其没有进行双向转诊的期望时，下转不同信息互联互通程度对下转意向的影响结果无统计学意义（p>0.05），上转不同信息互联互通程度对上转意向的影响结果有统计学意义（p<0.05）。在控制临床医生知觉行为控制的情况下，当医生下转知觉行为控制低，即临床医生认为自己对下转的控制力不高，认为下转难度较大时，不同信息互联互通程度对意向的影响结果有统计学差异（p<0.05）
3.双向转诊变量之间的相关性分析结果显示各因素间的相关关系都有统计学意义（p<0.01）。各因素与下转意向的相关系数：态度为0.428，主观规范为0.483、知觉行为控制为0.242、互联互通的为0.210。各因素与上转意向的相关系数：态度为0.321，主观规范为0.516、知觉行为控制为0.393、互联互通的为0.243。即双向转诊态度、主观规范、知觉行为控制、信息互联互通和双向转诊意向之间均成正相关关系。
4.各变量间的通径系数值及显著性检验结果均达到显著性水平。下转的结构方程模型分析结果显示，信息互联互通与知觉行为控制之间呈正相关，影响方式为直接影响且二者之间关系有显著性（p<0.001）。下转态度、主观规范、知觉行为控制与意向之间的关系有显著性（p<0.001），信息互联互通情况对知觉行为控制的影响以及知觉行为控制对意向的影响路径均有意义。上转的结构方程模型分析结果显示，信息互联互通与知觉行为控制之间呈正相关，影响方式为直接影响且二者之间关系有显著性（p<0.001）。上转态度、主观规范、知觉行为控制与意向之间的关系有显著性（p<0.05），信息互联互通情况对知觉行为控制的影响以及知觉行为控制对临床医生接收上转患者意向的影响路径均有意义。
研究结论：
信息互联互通情况对知觉行为控制有正向影响，并通过知觉行为控制对双向转诊的意向产生间接促进作用。同时，信息互联互通建设也与双向转诊态度和主观规范有相关关系。临床医生拥有更正向的意向、周围重要人群对临床医生转诊抱有期望时，信息互联互通程度越高，医生双向转诊的意向越高。但根据目前的调查结果显示，虽然被调查医院均属于医联体医院且有相应的信息系统，但医生认为信息系统的互联互通程度不高，且较难在当前联通程度下进行双向转诊，信息互联互通程度仍需进一步提升。

Objective:

Based on the theory of planned behavior, to establish a theoretical analysis model of the influence of information interconnection on doctors' two-way referral intention, analyze the influence mechanism of information interconnection on doctors' two-way referral intention, and provide the empirical basis and policy suggestions for promoting interconnection and two-way referral information system.

Contents:

1. Establish a theoretical framework of the influence of information interconnection on doctors' two-way referral intention.

2. Analyze clinicians' perception and belief in information interconnection and two-way referral intention in Medical Complex.

3. Analyze the influencing factors of information interconnection on the intention of two-way referral.

4. Establish a quantitative model of the influence of information interconnection on clinicians' two-way referral intention.

Methods:

A cross-sectional survey was carried out in Beijing, Jiangsu, Zhejiang and Shandong by sampling in typical areas in this study. This study established a theoretical model of the influence of information interconnection on doctors' two-way referral intention and behavior based on the theory of planned behavior. Descriptive analysis of data was carried out by percentage, mean and standard deviation. c² was used to test and analyze the influence of information interconnection on perceived behavior control. This study analyzed the influence of information interconnection on clinicians' two-way referral intention under the control of different individual characteristics, referral attitude, subjective norms and perceived behavior control. Pearson correlation analysis was used to explore the correlation among information connectivity, standard establishment, intention, attitude, subjective norms and perceived behavior control. Structural equation modeling (SEM) was used for multivariate analysis and a quantitative model was established.

Results:　

1. There were 625 clinicians investigated this time. 417 doctors thought that the current information was poorly connected, accounting for 66.7%. 208 doctors thought that the current information was well connected, accounting for 33.3%.

2. The influence of different information connectivity on two-way intention was statistically significant (P < 0.001) under the condition of controlling the two-way referral attitude of clinicians when clinicians had a positive attitude towards two-way referral. However, there was no significant difference between the degree of information interconnection and clinicians' two-way referral intention (p > 0.05) when doctors had no positive attitude towards two-way referral. The influence of different information connectivity on two-way intention was statistically significant (P < 0.001) under the condition of controlling the subjective norm of two-way referral when clinicians felt the expectation of two-way referral from important people around them. There was no significant difference in the influence of different information connectivity on downward turn intention (P > 0.05) when clinicians felt that there was no expectation of up-turn referral from important people around them, but there was a significant difference in the influence of different information connectivity on two-way intention (P < 0.05). The influence of different information connectivity on intention was statistically different (P < 0.05) under the condition of controlling the perceptual behavior control of clinicians when the perceptual behavior control of downward turn was low, that is, when clinicians thought that they had low control over downward turn and thought that downward turn was difficult.

3. The correlation between each dimension of two-way referral variables was statistically significant (P < 0.01). The correlation coefficients of downturn attitude, subjective norm, perceived behavior control, information interconnection and downturn intention were 0.428, 0.483, 0.242 and 0.210. The correlation coefficients of up-turn attitude, subjective norm, perceived behavior control, information interconnection and downturn intention were 0.321, 0.516, 0.393and 0.243, respectively, that is, two-way attitude, subjective norm, perceived behavior control, information interconnection and two-way intention were all positively correlated.

4. The path coefficient values and significance test results among the variables all reached the significance level. The results of the downward structural equation model analysis showed that there was a positive correlation between information interconnection and perceived behavior control, the influence mode was direct and the relationship between them was significant (P < 0.001). The relationship between downward subduction attitudes, subjective norms, perceptual behavioral control and intention was significant (P < 0.001). There was significance in the effect of information interconnection status on perceptual-behavioral control and the pathway of perceptual-behavioral control on intention.The results of the up-turn structural equation model analysis showed that there was a positive correlation between information interconnection and perceived behavior control, the influence mode was direct and the relationship between them was significant (P < 0.001).The relationship between sursumversion attitudes, subjective norms, perceptual behavioral control and intention was significant (P < 0.05). There was significance in the effect of information interconnection status on perceptual behavioral control and the pathway of perceptual behavioral control on clinicians' intention to receive upwardly referred patients.

Conclusions:

The establishment of information interconnection has a positive impact on perceptual behavior control and promotes the intention of two-way referral through perceptual behavior control. At the same time, the establishment of information interconnection is also related to the attitude and subjective norms of two-way referral. The important people around them have expectations for the referral of clinicians when clinicians have the intention to correct the direction, the higher the degree of information interconnection, the higher the intention of doctors to make a two-way referral. However, according to the current survey results, doctors think that the interconnection degree of information is not high although all the surveyed hospitals belong to Medical Complex hospitals and have corresponding information. It is difficult to make a two-way referral under the current interconnection degree, and the interconnection degree of information still needs to be further improved.