Background The hierarchical diagnosis and treatment system has become the top priority of deepening medical reform at present, and it is particularly important to understand its research hotspots and evolution.ObjectiveTo systematically summarize the development trend and evolution process of hierarchical diagnosis and treatment system in China and grasp its knowledge base, research hotspots and development trends, in order to provide scientific reference for subsequent research.Methods China National Knowledge Infrastructure(CNKI) database was used as the data source and "hierarchical diagnosis" "hierarchical treatment" "ladder network of medical prevention" "hierarchical medical system and division of labor in blocks" "hierarchical medical and service system and division of labor in blocks" "hierarchical medical system and division of labor" "initial diagnosis in community" "initial diagnosis at grassroots level" "treating acute and chronic diseases separately" "two-way referral" "cooperation between superior and subordinate medical institutions" "different division of labor in diagnosis" "different division of labor in treatment" "orderly medical diagnosis" "orderly medical treatment" "health service system+integration" "health service system+hierarchical" and "health service system+collaboration and division of labor" were used as key words to retrieve the documents related to the hierarchical diagnosis and treatment system in China from January to July in 2019.The retrieval time was from January 1, 1949 to July 31, 2019.Excel was used to retain and analyze the data, and descriptive statistical analysis was made on the authors, titles, document sources, publishing institutions, and volume of publications of the included documents.CiteSpace was used to obtain published journals, institutional cooperation and author distribution of the research results of China's hierarchical medical system.Through the analysis of high-frequency keywords, research hotspots were identified.Through time zone maps, clustering words and emergent words, the frontiers and development trends of the research were determined.Results In the end, 1233 articles were included, and the journal with the largest number of publications were Chinese General Practice〔287(23.28%)〕.The top five journals with the most published articles were all from the core database of Peking University Library(a total of 729 articles) with more than half of the total published articles.The institutions with high yield of research results were mainly centered around Huazhong University of Science and Technology, Capital Medical University, National Health Commission, Fudan University and Peking University.There were 68 core authors with a total of 457 articles, accounting for 37.28% of the total literature."Community health service" "medical alliance" "influencing factor" and "general practitioner" had always been hot topics in the research field of hierarchical diagnosis and treatment.The clustering labels of "patriotic health movement" "hospital bed" and "outpatient", and key words of "effect evaluation" "influencing factors" and "medical treatment" appeared from 1949 to 1978.The clustering labels of "medical treatment" and "medical insurance system", and key words of "community health service" "two-way referral" and "community health service institution" appeared from 1979 to 2008.The clustering labels of "grassroots medical and health institution" "combination of medical and nursing care" "medical service system" and "medical insurance", and key words of "medical service system" and "hierarchical diagnosis and treatment" appeared from 2009 to 2018.Conclusion The increase rate of literature of China's hierarchical diagnosis and treatment system is accelerated, but the quality of research results need to be further improved.There are a lot of cooperation among institutions, but the cooperation and communication among authors are limited, and no stable core author group has been formed.The research hotspots are gradually diversified and the research directions are continuously refined. How to find a new way of innovation from the institutional level through closer communication and collaboration is worthy of further study.

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