Kim Catherine, Williamson David F, Herman William H, Safford Monika M, Selby Joseph V, Marrero David G, Curb J David, Thompson Theodore J, Narayan K M Venkat, Mangione Carol M
Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Mich, USA.
Am J Manag Care. 2004 Feb;10(2 Pt 2):137-43.
To examine the effect of referral management on diabetes care.
Cross-sectional analysis.
Translating Research Into Action for Diabetes (TRIAD) is a multicenter study of managed care enrollees with diabetes. Prospective referral management was defined as "gatekeeping" and mandatory preauthorization from a utilization management office, and retrospective referral management as referral profiling and appropriateness reviews. Outcomes included dilated eye exam; self-reported visit to specialists; and perception of difficulty in getting referrals. Hierarchical models adjusted for clustering and patient age, gender, race, ethnicity, type and duration of diabetes treatment, education, income, health status, and comorbidity.
Referral management was commonly used by health plans (55%) and provider groups (52%). In adjusted analyses, we found no association between any referral management strategies and any of the outcome measures.
Referral management does not appear to have an impact on referrals or perception of referrals related to diabetes care.
探讨转诊管理对糖尿病护理的影响。
横断面分析。
“将糖尿病研究转化为行动”（TRIAD）是一项针对管理式医疗中糖尿病参保者的多中心研究。前瞻性转诊管理被定义为“把关”以及来自利用管理办公室的强制预先授权，回顾性转诊管理则为转诊分析和适宜性审查。研究结果包括散瞳眼科检查；自我报告的专科就诊情况；以及对获得转诊困难程度的感知。分层模型针对聚类以及患者的年龄、性别、种族、民族、糖尿病治疗类型和病程、教育程度、收入、健康状况和合并症进行了调整。
健康计划（55%）和医疗服务提供方组（52%）普遍采用转诊管理。在调整分析中，我们发现任何转诊管理策略与任何一项研究结果指标之间均无关联。
转诊管理似乎对与糖尿病护理相关的转诊或转诊感知没有影响。
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