Forrest Christopher B, Shadmi Efrat, Nutting Paul A, Starfield Barbara
Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Ann Fam Med. 2007 Jul-Aug;5(4):361-7. doi: 10.1370/afm.703.
This study describes referral completion from the perspectives of patients and primary care physicians and identifies predictors of adherence to the referral recommendation.
We observed a cohort of 776 referred patients from the offices of 133 physicians in 81 practices and 30 states. Referring physicians and patients completed self-administered questionnaires at the time of the referral decision and 3 months later.
Physicians reported that 79.2% of patients referred had a specialist visit, and 83.0% of patients indicated they completed the referral. The most common reasons for not completing the referral were "lack of time" and patient belief that the "health problem had resolved." The kappa statistic for patient-physician agreement on referral completion was 0.34, indicating only fair concordance. Patients in Medicaid plans were less likely than others to complete the referral, and more likely to experience a health plan denial. A longer duration of the patient relationship with the primary care physician and physician/staff scheduling of the specialty appointment were both positive predictors of referral completion.
About 8 in 10 patients referred from primary care complete a specialty referral within 3 months. Findings from this study suggest that referral completion rates may be increased by assisting patients with scheduling their specialty appointments and promoting continuity of care.
本研究从患者和初级保健医生的角度描述转诊完成情况，并确定遵循转诊建议的预测因素。
我们观察了来自30个州81家医疗机构中133名医生办公室的776名转诊患者队列。转诊医生和患者在转诊决定时及3个月后完成了自我管理的问卷。
医生报告称，79.2%的转诊患者进行了专科就诊，83.0%的患者表示他们完成了转诊。未完成转诊的最常见原因是“时间不足”以及患者认为“健康问题已解决”。患者与医生在转诊完成情况上的一致性kappa统计值为0.34，表明一致性仅为一般。参加医疗补助计划的患者比其他患者完成转诊的可能性更小，且更有可能遭到健康计划的拒绝。患者与初级保健医生的关系持续时间较长以及医生/工作人员安排专科预约均是转诊完成的积极预测因素。
从初级保健转诊的患者中，约十分之八的患者在3个月内完成了专科转诊。本研究结果表明，通过协助患者安排专科预约以及促进医疗连续性，可能会提高转诊完成率。
