PDF(Pubmed)
Abstract：
BACKGROUND: Inappropriate utilization of higher-level health facilities and ineffective management of referral processes in resource-limited settings are becoming increasingly a concern in health care management in developing countries. This is characterized by self-referral and frequent bypassing of the nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. On July 1, 2021, Kenyatta National Hospital (KNH) enforced the Kenya Health Sector Referral Implementation Guidelines, 2014, which required patients to receive approval from the KNH referral office and a formal referral letter to be admitted at KNH to reduce the number of walk-ins and allow KNH to function as a referral facility as envisioned by the Kenya 2010 Constitution and KNH legal statue of 1987.
OBJECTIVE: To determine the effect of enforcing the national referral guidelines on patterns of orthopaedic admissions to the KNH. This was a pre-post intervention study. Data abstraction was done for 459 and 446 charts before and after the enforcement of the national referral guidelines, respectively.
RESULTS: Enforcement of the national referral guidelines reduced the proportion of walk-in admissions from 54.9% to 45.1%, while the proportion of facility referrals increased from 46.6% to 53.4% (p = 0.013). The percentage of non-trauma orthopaedic admissions doubled from 12.0% to 22.4% (p<0.001). There was also an increase in admissions through the Outpatient Clinic and Corporate Outpatient Clinic. The proportion of emergency admissions declined, while that of elective admissions increased. The increase in elective cases was mainly driven by the increase in female admissions with active insurance cover, tertiary education, non-trauma-related conditions and older age groups. However, the use of official formal written referral letters did not change despite the enforcement of the national referral guidelines.
CONCLUSIONS: The enforcement of the national referral guidelines reduced the proportion of walk-ins\' admissions to KNH. While the enforcement of the national referral guidelines had no effect on the use of official formal written referral letters, it did limit access and utilization of inpatient orthopedic services for young male patients with no active insurance cover and in need of emergency orthopedic care.
OBJECTIVE: To determine the effect of enforcing the national referral guidelines on patterns of orthopaedic admissions to the KNH. This was a pre-post intervention study. Data abstraction was done for 459 and 446 charts before and after the enforcement of the national referral guidelines, respectively.
RESULTS: Enforcement of the national referral guidelines reduced the proportion of walk-in admissions from 54.9% to 45.1%, while the proportion of facility referrals increased from 46.6% to 53.4% (p = 0.013). The percentage of non-trauma orthopaedic admissions doubled from 12.0% to 22.4% (p<0.001). There was also an increase in admissions through the Outpatient Clinic and Corporate Outpatient Clinic. The proportion of emergency admissions declined, while that of elective admissions increased. The increase in elective cases was mainly driven by the increase in female admissions with active insurance cover, tertiary education, non-trauma-related conditions and older age groups. However, the use of official formal written referral letters did not change despite the enforcement of the national referral guidelines.
CONCLUSIONS: The enforcement of the national referral guidelines reduced the proportion of walk-ins\' admissions to KNH. While the enforcement of the national referral guidelines had no effect on the use of official formal written referral letters, it did limit access and utilization of inpatient orthopedic services for young male patients with no active insurance cover and in need of emergency orthopedic care.
摘要：
背景：在资源有限的环境中，对高级医疗机构的不当利用和转诊流程的无效管理正日益成为发展中国家卫生保健管理中的一个问题。其特点是自我转诊和经常绕过最近的保健设施，加上正规转诊机制较低。这种情况适用于在高成本的医疗机构中不必要地管理简单的医疗条件的情况。2021年7月1日，肯雅塔国家医院（KNH）执行了《肯尼亚卫生部门转诊实施指南》。2014年，要求患者获得KNH转诊办公室的批准，并在KNH接受正式的转诊信，以减少步入者的数量，并允许KNH作为肯尼亚2010年宪法和1987年KNH法律雕像所设想的转诊设施。
目的：确定执行国家转诊指南对KNH骨科入院模式的影响。这是一项干预前研究。在执行国家推荐指南之前和之后，对459和446个图表进行了数据提取，分别。
结果：国家转诊指南的实施将步入式入院的比例从54.9％降至45.1％，而设施转介的比例从46.6%增加到53.4%(p=0.013)。非创伤骨科入院的百分比从12.0%增加到22.4%(p<0.001)。门诊诊所和企业门诊诊所的入院人数也有所增加。急诊入院比例下降,而选修录取人数增加。选修个案的增加主要是由于有现役保险的女性入院人数增加,高等教育,非创伤相关疾病和老年群体。然而,尽管执行了国家转介指南，但官方正式书面转介信的使用并未改变。
结论：国家转诊指南的实施降低了KNH入院的比例。虽然国家转介准则的执行对正式书面转介信的使用没有影响，这确实限制了没有有效保险且需要紧急骨科护理的年轻男性患者获得和利用住院骨科服务。
目的：确定执行国家转诊指南对KNH骨科入院模式的影响。这是一项干预前研究。在执行国家推荐指南之前和之后，对459和446个图表进行了数据提取，分别。
结果：国家转诊指南的实施将步入式入院的比例从54.9％降至45.1％，而设施转介的比例从46.6%增加到53.4%(p=0.013)。非创伤骨科入院的百分比从12.0%增加到22.4%(p<0.001)。门诊诊所和企业门诊诊所的入院人数也有所增加。急诊入院比例下降,而选修录取人数增加。选修个案的增加主要是由于有现役保险的女性入院人数增加,高等教育,非创伤相关疾病和老年群体。然而,尽管执行了国家转介指南，但官方正式书面转介信的使用并未改变。
结论：国家转诊指南的实施降低了KNH入院的比例。虽然国家转介准则的执行对正式书面转介信的使用没有影响，这确实限制了没有有效保险且需要紧急骨科护理的年轻男性患者获得和利用住院骨科服务。
