Child and Adolescent Health Measurement Initiative, Oregon Health and Sciences University, Portland, OR 97239-2998, USA.
J Pediatr. 2011 Jan;158(1):24-30. doi: 10.1016/j.jpeds.2010.07.012.
To assess rates of incomplete specialty referral (referral not resulting in a specialist visit) and risk factors for incomplete referral in pediatric community health care centers.
In this cross-sectional study, we used referral records and electronic health records to calculate rate of incomplete referral in 577 children referred from two health care centers in underserved communities to any of 19 pediatric specialties at an affiliated tertiary care center, over 7 months in 2008-2009. We used logistic regression to test the association of incomplete referral with child/family sociodemographic and health care system factors.
Of the children, 30.2% had an incomplete referral. Incomplete referral rates were similar at the two health care centers, but varied from 10% to 73% according to specialty clinic type. In multivariate analysis, sociodemographic factors of older child age, public insurance status, and no chronic health conditions correlated with incomplete referral, as did health care system factors of surgical specialty clinic type, low patient volume, longer wait for visit, and appointment rescheduling.
Almost one-third of children referred to specialists were unable to complete the referral in a timely manner. To improve specialty access, health care organizations and policymakers should target support to families with high-risk children and remediate problematic health care system features.
评估儿科社区保健中心专科转介不完整（未导致专家就诊）的发生率和转介不完整的风险因素。
在这项横断面研究中，我们使用转介记录和电子健康记录，计算了 2008 年至 2009 年期间，在 7 个月内，从两个服务不足社区的两家医疗中心转介至附属三级医疗中心的 19 个儿科专科的 577 名儿童中，转介不完整的发生率。我们使用逻辑回归检验了转介不完整与儿童/家庭社会人口统计学和医疗保健系统因素之间的关联。
在这些儿童中，有 30.2%的儿童存在转介不完整的情况。两家医疗中心的转介不完整率相似，但根据专科诊所类型，转介不完整率从 10%到 73%不等。在多变量分析中，社会人口统计学因素中的儿童年龄较大、公共保险状况以及无慢性健康状况与转介不完整相关，医疗保健系统因素中的手术专科诊所类型、患者数量较少、就诊等待时间较长以及预约重新安排也与转介不完整相关。
近三分之一被转介至专科医生的儿童未能及时完成转介。为了改善专科就诊机会，医疗保健组织和政策制定者应针对高风险儿童的家庭提供支持，并改善有问题的医疗保健系统特征。
