Indiana University Center for Aging Research, 410 West 10th Street, suite 2000, Indianapolis, IN, 46202-3012, USA.
J Gen Intern Med. 2009 Jun;24(6):710-5. doi: 10.1007/s11606-009-0971-3. Epub 2009 Apr 15.
Failed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.
We determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.
Staggered implementation of a quality-improvement project, with comparison of intervention and control groups.
Patients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.
Faxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.
We compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.
Among 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.
With a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services.
专科医疗转介失败很常见，往往是医疗失误的表现。技术结构和流程是导致许多转介失败的原因。为亚专科评估安排预约是门诊转介和咨询的第一步。
我们旨在确定从纸质转介转变为具有自动跟踪功能的基于 Web 的系统是否与更多接受转介的患者预约相关。
质量改进项目的交错实施，比较干预组和对照组。
年龄在 21 岁及以上，由 11 个初级保健诊所中的任何一个转介到 25 个专科诊所中的任何一个。
用专家和通科医生都能使用的基于 Web 的应用程序取代传真转介，增强沟通并自动通知专科办公室。
我们比较了实施前后的预约情况以及从转介到预约的时间。使用逻辑回归分析进行调整，以考虑人口统计学因素。
在 40487 次转介中，干预前有 54%导致了专科预约，而干预后有 83%。没有干预时预约中位数时间为 168 天，有干预时为 78 天。当不产生重复转介时（单一订单为 54%，多个订单为 24%），预约增加更多。调整后，有干预的转介更有可能安排预约。
使用新的基于 Web 的转介系统，转介更有可能导致预约。该系统改善了获得专科医疗服务的机会。
