Abstract: Objective: To develop a hospice hierarchical referral service system and to evaluate its effects with the expectation of support provision for the development of hospice referral mechanisms at a later stage. Methods: The hospice hierarchical referral service system was determined by literature review, thematic analysis, Delphi expert inquire method. A quasi-experimental study design was adopted and 80 patients were randomly recruited from the medical institutions which were involved in the hierarchical referral service system in Nanjing. The upward and downward referral rate of the patients, satisfaction of patient's family members on the hierachical referral service, and the quality of death were collected and compared. Results: The positivity coefficients of two rounds of expert inquiries were both 100.0%. The authority coefficient of experts was 0.800 and 0.825, and the coordination coefficients were 0.141 and 0.632, respectively (P<0.01). The finalized hospice hierarchical referral service system included 4 first-level indicators (standards for hospice care in all levels of healthcare institutions, referral standards of patients, information-sharing mechanism, and quality control system), 14 second-level indicators, and 70 third-level indicators. The upward and downward referral rate, and quality of death were all optimized. Conclusion: The hospice hierarchical referral service system is scientific, reliable, specialized, and practical, which can provide important reference for better implementation of hospice hierarchical referral service.

Key words: hospice care; hierarchical referral; service system; Delphi expert inquire method