Division of Primary Care, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
J Gen Intern Med. 2009 May;24(5):614-9. doi: 10.1007/s11606-009-0955-3. Epub 2009 Mar 24.
Electronic referrals can improve access to subspecialty care in safety net settings. In January 2007, San Francisco General Hospital (SFGH) launched an electronic referral portal that incorporated subspecialist triage, iterative communication with referring providers, and existing electronic health record data to improve access to subspecialty care.
We surveyed primary care providers (PCPs) to assess the impact of electronic referrals on workflow and clinical care.
We administered an 18-item, web-based questionnaire to all 368 PCPs who had the option of referring to SFGH.
We asked participants to rate time spent submitting a referral, guidance of workup, wait times, and change in overall clinical care compared to prior referral methods using 5-point Likert scales. We used multivariate logistic regression to identify variables associated with perceived improvement in overall clinical care.
Two hundred ninety-eight PCPs (81.0%) from 24 clinics participated. Over half (55.4%) worked at hospital-based clinics, 27.9% at county-funded community clinics, and 17.1% at non-county-funded community clinics. Most (71.9%) reported that electronic referrals had improved overall clinical care. Providers from non-county-funded clinics (AOR 0.40, 95% CI 0.14-0.79) and those who spent > or =6 min submitting an electronic referral (AOR 0.33, 95%CI 0.18-0.61) were significantly less likely than other participants to report that electronic referrals had improved clinical care.
PCPs felt electronic referrals improved health-care access and quality; those who reported a negative impact on workflow were less likely to agree. While electronic referrals hold promise as a tool to improve clinical care, their impact on workflow should be considered.
电子转诊可以改善安全网环境下的专科医疗服务获取途径。2007 年 1 月，旧金山总医院（SFGH）推出了一个电子转诊门户，该门户整合了专科分诊、与转诊医生的迭代沟通，以及现有的电子健康记录数据，以改善专科医疗服务的可及性。
我们调查了初级保健医生（PCPs），以评估电子转诊对工作流程和临床护理的影响。
我们向所有有资格向 SFGH 转诊的 368 名 PCPs 发放了一份 18 项的网络问卷。
我们请参与者使用 5 分制量表对提交转诊的时间、检查指导、等待时间以及与之前的转诊方法相比整体临床护理的变化进行评分。我们使用多变量逻辑回归来确定与整体临床护理改善相关的变量。
来自 24 个诊所的 298 名 PCPs（81.0%）参与了调查。超过一半（55.4%）的医生在医院诊所工作，27.9%在县资助的社区诊所工作，17.1%在非县资助的社区诊所工作。大多数（71.9%）人表示，电子转诊改善了整体临床护理。非县资助诊所的医生（AOR 0.40，95%CI 0.14-0.79）和提交电子转诊时间大于等于 6 分钟的医生（AOR 0.33，95%CI 0.18-0.61）比其他参与者更不可能报告电子转诊改善了临床护理。
PCPs 认为电子转诊改善了医疗服务的可及性和质量；那些报告对工作流程有负面影响的人则不太可能认同这一点。虽然电子转诊作为改善临床护理的工具具有很大的潜力，但应考虑其对工作流程的影响。
