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BMC Health Services Research Jul 2011Performance of specialty referrals is coming under scrutiny, but a lack of identifiable measures impedes measurement efforts. The objective of this study was to... (Review)
Review
BACKGROUND
Performance of specialty referrals is coming under scrutiny, but a lack of identifiable measures impedes measurement efforts. The objective of this study was to systematically review the literature to identify published measures that assess specialty referrals.
METHODS
We performed a systematic review of the literature for measures of specialty referral. Searches were made of MEDLINE and HealthSTAR databases, references of eligible papers, and citations provided by content experts. Measures were eligible if they were published from January 1973 to June 2009, reported on validity and/or reliability of the measure, and were applicable to Organization for Economic Cooperation and Development healthcare systems. We classified measures according to a conceptual framework, which underwent content validation with an expert panel.
RESULTS
We identified 2,964 potentially eligible papers. After abstract and full-text review, we selected 214 papers containing 244 measures. Most measures were applied in adults (57%), assessed structural elements of the referral process (60%), and collected data via survey (62%). Measures were classified into non-mutually exclusive domains: need for specialty care (N = 14), referral initiation (N = 73), entry into specialty care (N = 53), coordination (N = 60), referral type (N = 3), clinical tasks (N = 19), resource use (N = 13), quality (N = 57), and outcomes (N = 9).
CONCLUSIONS
Published measures are available to assess the specialty referral process, although some domains are limited. Because many of these measures have been not been extensively validated in general populations, assess limited aspects of the referral process, and require new data collection, their applicability and preference in assessment of the specialty referral process is needed.
Topics: Humans; Medicine; Program Evaluation; Quality of Health Care; Referral and Consultation
PubMed: 21752285
DOI: 10.1186/1472-6963-11-168 -
Zeitschrift Fur Rheumatologie Mar 2020The initial presentation of patients with symptoms indicative of a rheumatic disease is in most cases not directly to a rheumatologist. This study evaluated the...
BACKGROUND
The initial presentation of patients with symptoms indicative of a rheumatic disease is in most cases not directly to a rheumatologist. This study evaluated the following questions: I. Which medical specialists refer patients to a department of rheumatology? II. Evaluation of the accordance of the presumptive referral diagnosis and the final diagnosis by a rheumatologist.
METHODS
A total of 947 patients (279 men and 668 women) who initially presented to a university hospital for rheumatological diagnostics were included in the study. The referring medical specialist fields were identified. Furthermore, a kappa analysis was performed to evaluate the accordance of the presumptive referral diagnosis and the final diagnosis generated after a rheumatological evaluation of the patients.
RESULTS
Of the referrals 73% were initiated by general practitioners or internists functioning as general practitioners. The other referrers were 5% specialists in internal medicine (excluding rheumatology), 4% orthopedic/trauma surgeons, 1% other surgeons and 4% other specialist fields. A rheumatological diagnosis was made in 58% of the patients and rheumatological inflammatory joint diseases (26%), collagenosis (14%) and vasculitides (5%) were the most frequently diagnoses. The accordance of the presumptive diagnosis of the general practitioners and the final diagnosis after rheumatological evaluation was a kappa coefficient of κ = 0.304. Lower kappa values were evaluated for orthopedic surgeons (κ = 0.277) and other specialists (κ = 0.200).
CONCLUSION
The referrals to a rheumatology institution were frequently initiated by general practitioners and internists functioning as general practitioners. In this context the presumptive diagnosis of general practitioners showed a low accordance with the final rheumatological diagnosis. In contrast, a detailed presumptive diagnosis is desirable for optimal use of the limited resources for rheumatological care.
Topics: Female; Humans; Internal Medicine; Male; Referral and Consultation; Rheumatic Diseases; Rheumatologists; Rheumatology
PubMed: 31388735
DOI: 10.1007/s00393-019-0672-1 -
Irish Journal of Medical Science Mar 2015During 2009, there were 3.3 million outpatient attendances at outpatient clinics across Ireland. Up to 20 % of these are directed towards ENT services.
BACKGROUND
During 2009, there were 3.3 million outpatient attendances at outpatient clinics across Ireland. Up to 20 % of these are directed towards ENT services.
AIMS
To determine the compliance rate of general practitioners with the ICGP referral guidelines.
METHODS
One-hundred referrals received were compared to the ICGP standardised form and graded accordingly. Each referral letter was graded to a maximum of 37 points.
RESULTS
The average score recorded for referrals was 16/37. The referrer detail section scored the highest with a mean of 75.42 % (paediatric referrals) and 72.9 % (adult referrals). The clinical information provided demonstrated compliance rates of 34 % (paediatrics) and 35 % (adults). In total, only 32 letters made any reference to findings on examination. Both paediatric and adult referrals scored an average of 42 % when patients' details are considered.
CONCLUSION
This study demonstrates poor compliance rates with the introduced ICGP standardised referral form, which has implications for the accurate grading of referral letters received.
Topics: Adult; Child; Female; General Practice; Guideline Adherence; Humans; Ireland; Male; Medical Audit; Otolaryngology; Practice Guidelines as Topic; Referral and Consultation
PubMed: 24526577
DOI: 10.1007/s11845-014-1075-6 -
The Journal of Nursing Administration Dec 1992Home health agencies are dependent on referrals for survival, and sources for referrals are limitless. It is imperative that administrators have systems in place to...
Home health agencies are dependent on referrals for survival, and sources for referrals are limitless. It is imperative that administrators have systems in place to accept referrals, including all data that are pertinent to the care of the patient, collect and maintain referral source data to use as one aspect of the agency's internal evaluation process, and target its marketing efforts. A home health agency must have approved policies and procedures available that address criteria for admission, continuation, and discharge from service. These must be shared with the personnel of the referral sources. The admission criteria should state the types of referrals that are not appropriate for service and how these referrals will be handled. As part of the overall management of the agency, administrators must also be aware of seasonal trends and how they may affect staffing and total budget. A positive relationship between the staff of the home health agency and the referral source is one way to generate needed referrals. The end result will benefit the patient, the agency, and the referring source.
Topics: Budgets; Data Collection; Financial Management; Home Care Services; Humans; Interinstitutional Relations; Marketing of Health Services; Nurse Administrators; Organizational Policy; Referral and Consultation; Seasons
PubMed: 1469486
DOI: No ID Found -
The British Journal of General Practice... Nov 2003Innovations are proliferating at the primary-secondary care interface, affecting referral to secondary care and resource use. Evidence about the range of effects and... (Review)
Review
BACKGROUND
Innovations are proliferating at the primary-secondary care interface, affecting referral to secondary care and resource use. Evidence about the range of effects and implications for the healthcare system of different types of innovation have not previously been summarised.
AIM
To review the available evidence on initiatives affecting primary care referral to specialist secondary care.
SETTING
Studies of primary-secondary care interface.
METHOD
Systematic review of trials, using adapted Cochrane Collaboration (effective practice and organisation of care) criteria. Studies from 1980 to 2001 were identified from a wide range of sources. Strict inclusion criteria were applied, and relevant clinical, service and cost data extracted using an agreed protocol. The main outcome measures were referral rates to specialist secondary care.
RESULTS
Of the 139 studies initially identified. 34 met the review criteria. An updated search added a further 10 studies. Two studies provided economic analysis only. Referral was not the primary outcome of interest in the majority of included studies. Professional interventions generally had an impact on referral rates consistent with the intended change in clinician behaviour. Similarly, specialist 'outreach' or other primary care-based specialist provider schemes had at least a small effect upon referral rates to secondary care with the direction of effect being that intended or rational from a clinical and sociological perspective. Of the financial interventions, one was aimed primarily at changing the numbers or proportion of referrals from primary to specialist secondary care, and the direction of change was as expected in all cases. The quality of the reporting of the economic components of the 14 studies giving economic data was poor in many cases. When grouped by intervention type, no overall pattern of change in referral costs or total costs emerged.
CONCLUSION
The studies identified were extremely diverse in methodology, clinical subject, organisational form, and quality of evidence. The number of good quality evaluations of innovative schemes to enhance the existing capacity of primary care was small, but increasing. Well-evaluated service initiatives in this area should be supported. Organisational innovations in the structure of service provision need not increase total costs to the National Health Service (NHS), even though costs associated with referral may increase. This review provides limited, partial, and conditional support for current primary care-oriented NHS policy developments in the United Kingdom.
Topics: Family Practice; Health Services Needs and Demand; Humans; Medicine; Organizational Innovation; Practice Patterns, Physicians'; Primary Health Care; Referral and Consultation; Specialization
PubMed: 14702909
DOI: No ID Found -
Emergency Medicine Journal : EMJ Oct 2014Making an effective telephone referral is an important skill for an emergency department (ED) clinician. It is essential for patient safety that the information is...
INTRODUCTION
Making an effective telephone referral is an important skill for an emergency department (ED) clinician. It is essential for patient safety that the information is conveyed in a succinct manner to the correct inpatient specialty. The aim of this study was to assess: the impact of grade of staff making the referral; specialty referred to; and condition or patient problem. It also aimed to identify current problems or barriers in the referral process.
METHODS
This prospective study took place in one large teaching hospital in the UK. There were two parts: data collection to obtain information on each referral made by ED staff; and questionnaires administered to obtain opinions on the current referral process from both staff making and receiving the referrals.
RESULTS
Data were collected over 6 days and included 362 referrals. The mean evaluation of the referral process (scored 0-4) for all referrals was 3.34 (SD 0.95). 22 ED staff responding (64.7%) felt that some specialties were more difficult to refer to than others. 60.6% of non-ED staff accepting referrals felt they would like some form of senior ED screening process prior to referral compared with 20.6% of ED staff. The most common topics commented on were communication, education and process.
DISCUSSION
There are differences in understanding and opinion between ED and non-ED staff about the referral process. There are also factors which influence ease of referral: specialty referring to and patient problem. More intervention studies are required to identify solutions that can be implemented and sustained in routine practice.
Topics: Attitude of Health Personnel; Communication; Data Collection; Emergency Service, Hospital; Humans; Prospective Studies; Referral and Consultation; Specialization; Surveys and Questionnaires; Telephone; United Kingdom
PubMed: 23872528
DOI: 10.1136/emermed-2013-202532 -
The Ulster Medical Journal May 2011Current NHS guidelines require patients with suspected breast cancer to be seen urgently at a specialist breast clinic. The aim of this study was to assess referral...
INTRODUCTION
Current NHS guidelines require patients with suspected breast cancer to be seen urgently at a specialist breast clinic. The aim of this study was to assess referral patterns and clinical findings of patients referred to a specialist breast clinic.
MATERIALS AND METHODS
A prospective database was maintained for consecutive patients referred. Symptoms and clinical findings in primary and secondary care were recorded. Correlation with final diagnoses was made. Tertiary referral patients were excluded.
RESULTS
1098 patients attended a specialist breast clinic over six months. 588 (54%) were referred as urgent, 285 (26%) routinely and 225 (20%) were unspecified. 492 (45%) patients were referred with the incorrect referral priority. 42 patients were unexamined in primary care. Examination findings in primary and secondary care correlated in only 487 (46%) patients. Examination in primary care when compared with secondary care was highly sensitive for detecting breast lumps, but specificity was low. 86 patients (8%) were diagnosed with breast cancer, 72 (84%) were referred urgently, 6 (7%) routinely and 8 (9%) as unspecified priority. Regardless of the clinical expertise of the referrer, sensitivity and specificity of the two-week guidelines for cancer are low.
CONCLUSIONS
Examination findings in primary and secondary care correlate in only 46% of referrals. Additionally, 55% of referrals were of the correct priority. The two-week rule guidelines have poor sensitivity and specificity for cancer. The safest and fairest policy would be to abandon the concept of urgent referral criteria and see all patients in a timely fashion. Alternatively, simplifying the referral criteria would improve sensitivity and specificity for cancer without leading to increased waiting times.
Topics: Aged; Breast Neoplasms; Chi-Square Distribution; Cohort Studies; Female; Health Services Accessibility; Humans; Ireland; Middle Aged; Practice Guidelines as Topic; Primary Health Care; Prospective Studies; Referral and Consultation; Sensitivity and Specificity; Statistics, Nonparametric; Waiting Lists
PubMed: 22347745
DOI: No ID Found -
Academic Emergency Medicine : Official... 1994Since emergency physicians (EPs) frequently initiate referrals and consultations, accept patients in referral, and may provide consultation services, it is imperative...
Since emergency physicians (EPs) frequently initiate referrals and consultations, accept patients in referral, and may provide consultation services, it is imperative that EPs fully understand these processes. Such an understanding improves communication and facilitates professional interactions and patient care. There is little published information concerning the significance and practice of referrals and consultations as they pertain to the EP. This article addresses referrals and consultations in relation to EPs. Specific recommendations are made for consultation initiation and execution. The dynamics and ethical/legal issues associated with initiating and accepting referrals and consultations are discussed.
Topics: Consultants; Emergency Medicine; Ethics, Medical; Humans; Physician-Patient Relations; Referral and Consultation; United States
PubMed: 7600406
DOI: 10.1111/j.1553-2712.1994.tb02557.x -
Health Policy and Planning Dec 1998The first nationwide study on a patient referral system was conducted in Honduras. It covered all 25 public hospitals (six National, five Regional and 14 Area Hospitals)...
The first nationwide study on a patient referral system was conducted in Honduras. It covered all 25 public hospitals (six National, five Regional and 14 Area Hospitals) and 24 major health centres. Based on 46,739 reviews of patient records, 226 'received referral' and 1072 'sent referral' cases were analyzed by age and sex of the patient, diagnosis on referral, institution from or to which the case was referred, use of proper referral form, and reception of reply for referrals. At the same time, the study team supervised the function of the registry and management of patient records at each institution. The average referral rate by the level of health facility was 15.8% at National, 4.0% at Regional, 2.8% at Area Hospitals, and 0.8% at health centres. The referral rate was observed to be higher when institutional managers emphasized the importance of the referral system. Only 1.4% of referrals received a reply from upper level institutions. The most common cases for referral were neurological at National, obstetric at Regional and respiratory cases at Area Hospitals. The use rate of the standard referral form was 70 to 80% at hospitals and 60% at health centres. There was no norm to duplicate referral letters for record keeping. The patient referral system has not developed satisfactorily in Honduras. The main problems were: 1) low referral rate at all levels of institution, 2) evident by-pass phenomenon at intermediate hospitals, 3) inadequate health information system for patient referral, and 4) misunderstanding of the terminology of referral by health personnel. The following recommendations were made: guarantee of essential health services at peripheral institutions, development of an effective information system for patient referral, facilitation of frequent reply for referrals, elaboration of referral case discussion between institutions, patient education on proper use of health facilities, and restructuring the health service network in the two major cities.
Topics: Community Health Centers; Developing Countries; Forms and Records Control; Health Services Research; Honduras; Hospitals, Public; Management Audit; Medical Audit; Referral and Consultation; Regional Medical Programs
PubMed: 10346035
DOI: 10.1093/heapol/13.4.433 -
Surgical Endoscopy Dec 2017The Ontario Bariatric Network implemented an online referral system to completely replace a fax-based system in 2015. Strategies such as electronic information transfer...
BACKGROUND
The Ontario Bariatric Network implemented an online referral system to completely replace a fax-based system in 2015. Strategies such as electronic information transfer have been suggested to improve the bariatric referral process but few studies exist demonstrating their efficacy. Therefore, the purpose of this study was to determine the impact on referral rates to bariatric surgery after converting to an online referral system from a fax-based system.
METHODS
All referrals from 2011 to 2015 were included in the study. The main outcomes included the total number of referrals and whether a practitioner increased referrals after the implementation of the online referral system. A hierarchical logistic regression model was used for the final analysis. Predictors of interest included physician and neighbourhood level factors RESULTS: Referrals more than doubled overall and increased significantly across all health regions. Compared to practitioners in their first five years, all other experience groups were approximately 50% less likely to increase referrals. Compared to those within 50 km of a bariatric facility, practitioners 50-99 km (OR 0.76 95% CI 0.58-0.98 p = 0.04) and 100-199 km (OR 0.73 95% CI 0.55-0.96 p = 0.03) away were both significantly less likely to increase referrals.
CONCLUSION
This study found that referrals increased significantly after implementing an online referral system. Furthermore, physicians in their first five years of practice as well as those practicing closer to bariatric centers were more likely to increase referrals. Our findings demonstrate that an online referral system may aid in increasing referrals to bariatric surgery.
Topics: Bariatric Surgery; Female; Humans; Internet; Logistic Models; Longitudinal Studies; Male; Ontario; Practice Patterns, Physicians'; Primary Health Care; Referral and Consultation
PubMed: 28447254
DOI: 10.1007/s00464-017-5578-x