# Construction and Evaluation of the Bidirectional Referral System in Internet Hospital: Case Study of Children’s Hospital in Western China

## TL;DR

This study compares traditional and internet-based referral systems in a children's hospital, finding that the internet system is faster and cheaper but still has low downward referrals.

## Contribution

The study introduces a systematic framework for internet-based bidirectional referral systems and evaluates their performance in pediatric care.

## Key findings

- The IBR system reduced median referral time by 64% compared to the TBR system.
- Postreferral medical expenses were significantly lower in the IBR group.
- Respiratory departments had the highest upward referrals, with pneumonia being the most common diagnosis.

## Abstract

The World Health Organization (WHO) emphasizes internet IT as pivotal for optimizing health care system efficiency. Traditional bidirectional referral (TBR) systems, hindered by manual processes and information asymmetry, face challenges in pediatric care. While internet bidirectional referral (IBR) systems demonstrate effectiveness compared to TBR methods, comparative performance analyses remain remarkably scarce.

This study aims to develop a systematic and standardized bidirectional referral framework for internet hospitals and analyze the differences in core referral indicators of referral time and postreferral medical expenses between TBR (2019‐2021) and IBR (2022‐2024) at the Children’s Hospital of Chongqing Medical University.

This study is a retrospective cohort study that includes patients aged 0‐18 years with chronic diseases and complex cases in both TBR and IBR periods, while excluding emergency cases. We compared the differences between TBR and IBR across multiple dimensions, including demographic characteristics, downward-to-upward transfer ratio, core indicators (referral times and postreferral medical expenses) and referred diseases, and medical departments.

This study included a total of 457 referral cases, with 106 in the TBR group (79 upward and 27 downward, resulting in a downward-to-upward referral ratio of 34.18%) and 351 in the IBR group (329 upward and 22 downward, resulting in a downward-to-upward referral ratio of 6.69%). Compared with the TBR group, the median referral time in the IBR group was significantly shorter (0.90 d vs 2.51 d; P<.001), and the median postreferral medical expenses were lower (¥13,091.16 [US $1822.34] vs ¥8380.59 [US $1166.61]; P=.01). We observed that in both groups, the respiratory department consistently ranked as the top specialty for upward referrals, with pneumonia emerging as the most prevalent diagnosis for such transfers.

In pediatric care, the IBR system improved referral efficiency and reduced postreferral medical expenses compared with TBR methods, but there is still a low downward referral rate. While the IBR system shows promise and merits widespread adoption, further validation across diverse medical institutions and broader populations is necessary.