Skip to main content Skip to main navigation menu Skip to site footer

A referral system implementation of health services from 2013 - 2022: a bibliometric analysis

  • Nur Hidayani ,
  • Winny Setyonugroho ,


Background: Research related to the implementation of the referral system still needs to be conducted in more depth because there are still problems and obstacles in the implementation of the referral system along with the development of the health service system in recent years. This study aims to determine the development of research on referral system implementation in health services from 2013 to 2022.

Methods: This research category is qualitative with a literature study. This research uses the Scopus search engine to search for journals related to the implementation of the referral system from 2013 to 2022, with keywords "implementation" AND "referral system" with subject area restrictions related to referral system in health care, the document type is an article and English language. This research also uses VOSviewer and R-Studio for data mapping and analysis.

Results: From this research, 222 English-language articles were selected. Research publications are increasing in 2020, 2021, and 2022. Fondazione IRCSS Istituto Nazionale Dei Tumori Sn and Tabriz University of Medical Sciences contributed the most publications in this study. The journal BMC Health Services Research published the most articles on referral system implementation; Petersen, I. Rashidian, A., and Putoto, G. were the top authors on this research topic. The word human was found 196 times, the female was found 177 times, and the patient referral was found 139 times. From the VOSviewer visualization analysis, topics such as disease case groups (neoplasms, Human Immunodeficiency Virus), digitalization of health services (electronic health records, telemedicine, telehealth), and related developing countries such as Ethiopia and India, and underdeveloped countries such as Tanzania still have excellent opportunities for future research.

Conclusion: This research is dominated by developed countries, so research in developing countries needs to be reproduced and developed. Data sources from the Web of Science are recommended for future research.



  1. Teklu AM, Litch JA, Tesfahun A, Wolka E, Tuamay BD, Gidey H, et al. Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: A qualitative assessment. BMC Pediatr. 2020;20(1).
  2. Daniels AA, Abuosi A. Improving emergency obstetric referral systems in low and middle income countries: A qualitative study in a tertiary health facility in Ghana. BMC Health Serv Res. 2020;20(1).
  3. Sokhanvar M, Kabir MJ, Bevrani H, Nosratnejad S, Hasanpoor E, Janati A. The role of the urban family physician plan in utilization of outpatient services in Iran. Fam Med Prim Care Rev. 2020;22(4):331–7.
  4. Zhuang Q, Peng Y, Zhou J, Coyte P. Research on the child health-care system in China from the perspective of equal health benefits: Beijing as the case study. Child Care Health Dev. 2022;48(4):513–20.
  5. Suryoputro A, Budiyanti RT. Development Framework of Emergency Call Application in Pregnant Women. JMMR (Jurnal Medicoeticolegal dan Manaj Rumah Sakit). 2019 Dec 20;8(3):179–85.
  6. Schirmer CM, Binning MJ, Fox WC, James RF. Delayed presentation of acute ischemic strokes during the COVID-19 crisis. J NeuroIntervent Surg. 2020;12:639–42.
  7. Pittalis C, Brugha R, Gajewski J. Surgical referral systems in low- And middle-income countries: A review of the evidence. PLoS One. 2019 Sep 1;14(9).
  8. Nango OW, Mwangi EM, Oluoch M. Determinants of a functional referral system in Kisumu county, Kenya patients’ perspective. Glob J Heal Sci. 2019;4,(1):11–31.
  9. Oduro-Mensah E, Agyepong IA, Frimpong E, Zweekhorst M, Vanotoo LA. Implementation of a referral and expert advice call Center for Maternal and Newborn Care in the resource constrained health system context of the Greater Accra region of Ghana. BMC Pregnancy Childbirth. 2021;21(1).
  10. Rong H, Tu L. Research on the construction of the referral networks of city hospitals and invulnerability in response to major public health emergency. ITM Web Conf. 2022;45:01079.
  11. Aden JA, Ahmed HJ, Östergren PO. Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach. Glob Health Action. 2019;12(1).
  12. Vargas I, Garcia-Subirats I, Mogollón-Pérez AS, Ferreira-De-Medeiros-Mendes M, Eguiguren P, Cisneros AI, et al. Understanding communication breakdown in the outpatient referral process in Latin America: A cross-sectional study on the use of clinical correspondence in public health-care networks of six countries. Health Policy Plan. 2018;33(4):494–504.
  13. Naseriasl M, Janati A, Amini A, Adham D. Referral system in rural Iran: Improvement proposals . Cad Saude Publica. 2018;34(3).
  14. León-Arce HG, Mogollón-Pérez AS, Vargas Lorenzo I, Vázquez Navarrete ML. Factors influencing the use of mechanisms for coordinating health-care levels in Colombia . Gac Sanit. 2021;35(2):177–85.
  15. Huang J, Mao LX, Liu HC, Song M shun. Quality function deployment improvement: A bibliometric analysis and literature review. Qual Quant. 2022;56(3):1347–66.
  16. van Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010;84(2):523–38.
  17. Merigó JM, Mulet-Forteza C, Martorell O, Merigó-Lindahl C. Scientific research in the tourism, leisure and hospitality field: a bibliometric analysis. Anatolia. 2020;31(3):494–508.
  18. Pan X, Yan E, Cui M, Hua W. Examining the usage, citation, and diffusion patterns of bibliometric mapping software: A comparative study of three tools. J Informetr. 2018;12(2):481–93.
  19. Guleria D, Kaur G. Bibliometric analysis of ecopreneurship using VOSviewer and RStudio Bibliometrix, 1989–2019. Libr Hi Tech. 2021;39(4):1001–24.
  20. Sephton BM, Morley H, Mahapatra P, Shenouda M, Al-Yaseen M, Bernstein DE, et al. The impact of digitisation of a virtual fracture clinic on referral quality, outcomes and assessment times. Eur J Trauma Emerg Surg. 2022;48(2):1327–34.
  21. Harahap NC, Handayani PW, Hidayanto AN. Barriers and technologies of maternal and neonatal referral system in developing countries: A narrative review. Informatics Med Unlocked. 2019;15.
  22. Malakoane B, Heunis JC, Chikobvu P, Kigozi NG, Kruger WH. Public health system challenges in the Free State, South Africa: A situation appraisal to inform health system strengthening. BMC Health Serv Res. 2020;20(1).
  23. Loftus TJ, Wu Q, Wang Z, Lysak N, Moore FA, Bihorac A, et al. Delayed interhospital transfer of critically ill patients with surgical sepsis. J Trauma Acute Care Surg. 2020;88(1):169–75.
  24. Ofosu B, Ofori D, Ntumy M, Asah-Opoku K, Boafor T. Assessing the functionality of an emergency obstetric referral system and continuum of care among public health-care facilities in a low resource setting: an application of process mapping approach. BMC Health Serv Res. 2021;21(1).
  25. Spagnolo J, Breton M, Sasseville M, Sauvé C, Clément JF, Fleet R, et al. Exploring the implementation and underlying mechanisms of centralized referral systems to access specialized health services in Quebec. BMC Health Serv Res. 2021;21(1).
  26. Upadhaya N, Regmi U, Gurung D, Luitel NP, Petersen I, Jordans MJD, et al. Mental health and psychosocial support services in primary health care in Nepal: Perceived facilitating factors, barriers and strategies for improvement. BMC Psychiatry. 2020;20(1).
  27. Caviglia M, Buson R, Pini S, Jambai A, Vandy MJ, Venturini F, et al. The National Emergency Medical Service Role during the COVID-19 Pandemic in Sierra Leone. Prehosp Disaster Med. 2020;35(6):693–7.
  28. Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H. Family medicine in Iran: facing the health system challenges. Glob J Health Sci. 2015;7(3):260–6.
  29. Lobelo F, Stoutenberg M, Hutber A. The exercise is medicine global health initiative: A 2014 update. Br J Sports Med. 2014;48(22):1627–33.
  30. Barrett TW, Garland NM, Freeman CL, Klar K, Dahlke J, Lancaster P, et al. Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings. Ann Emerg Med. 2022;80(3):235–42.
  31. Anastasi E, Borchert M, Campbell OMR, Sondorp E, Kaducu F, Hill O, et al. Losing women along the path to safe motherhood: Why is there such a gap between women’s use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda. BMC Pregnancy Childbirth. 2015;15(1).
  32. Murray SF, Hunter BM, Bisht R, Ensor T, Bick D. Effects of demand-side financing on utilisation, experiences and outcomes of maternity care in low- and middle-income countries: A systematic review. BMC Pregnancy Childbirth. 2014;14(1).
  33. Penn-Kekana L, Pereira S, Hussein J, Bontogon H, Chersich M, Munjanja S, et al. Understanding the implementation of maternity waiting homes in low- and middle-income countries: A qualitative thematic synthesis. BMC Pregnancy Childbirth. 2017;17(1).
  34. Sami S, Amsalu R, Dimiti A, Jackson D, Kenyi S, Meyers J, et al. Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: A mixed methods case study. BMC Pregnancy Childbirth. 2018;18(1).
  35. Oduro-Mensah E, Agyepong IA, Frimpong E, Zweekhorst M, Vanotoo LA. Implementation of a referral and expert advice call Center for Maternal and Newborn Care in the resource constrained health system context of the Greater Accra region of Ghana. BMC Pregnancy Childbirth. 2021;21(1).
  36. Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet. 2019;394(10204):1192–204.
  37. Fernández-Méndez R, Wong MY, Rastall RJ, Rebollo-Díaz S, Oberg I, Price SJ, et al. Improvement of the efficiency and completeness of neuro-oncology patient referrals to a tertiary center through the implementation of an electronic referral system: Retrospective cohort study. J Med Internet Res. 2020;22(3).

How to Cite

Hidayani, N. ., & Setyonugroho, W. . (2022). A referral system implementation of health services from 2013 - 2022: a bibliometric analysis. Indonesia Journal of Biomedical Science, 16(2), 158–165.




Search Panel