University of Calgary, Calgary, Alberta, Canada.
Arthritis Care Res (Hoboken). 2011 Feb;63(2):231-9. doi: 10.1002/acr.20366.
Timely access to rheumatology consultation is fundamental to appropriate and effective management of patients with musculoskeletal and autoimmune diseases. Yet, for a variety of reasons, limited and delayed access is commonplace. Moreover, information exchange for referral is often inadequate or poorly communicated. The objective of this work was to improve referral from primary care to rheumatology by formulating and testing a clinically coherent, reliable, and non-diagnosis-dependent Priority Referral Score (PRS).
Using a deliberative process, a clinical panel of 10 primary care providers (PCPs) and rheumatology specialists reviewed clinical case scenarios and engaged in a highly iterative process to develop criteria, definitions, and weights for the PRS, a linear 100-point scale to rate the relative urgency of referral. Following tool formulation, clinicians uninvolved with the process tested the PRS against their clinical judgment.
The PRS comprises 8 criteria, with 2-4 levels for each criterion, and each having a weight generated through conjoint analysis, which forced choices around the comparative urgency of all of the criteria and levels. The PRS showed a strong correlation between clinical rankings of rheumatologists and PCPs in both the deliberative panel, and the physicians subsequently involved in the testing of the PRS.
No standardized priority-setting criteria are available for the full range of primary care referrals to rheumatologists. The PRS had face value with panelists and provided acceptable interrater and intrarater reliability when tested with other rheumatologists and PCPs. Pilot testing with other clinicians and in other settings is justified and prerequisite to use in clinical practice.
及时获得风湿病学咨询对于肌肉骨骼和自身免疫性疾病患者的适当和有效管理至关重要。然而，由于各种原因，有限和延迟的咨询很常见。此外，转诊信息交流通常不足或沟通不畅。这项工作的目的是通过制定和测试临床一致、可靠且不依赖于诊断的优先转诊评分（PRS）来改善从初级保健到风湿病学的转诊。
使用审议过程，由 10 名初级保健提供者（PCP）和风湿病专家组成的临床小组审查了临床病例，并进行了高度迭代的过程，以制定 PRS 的标准、定义和权重，这是一个线性的 100 分制，用于评估转诊的相对紧迫性。在制定工具后，未参与该过程的临床医生根据他们的临床判断测试 PRS。
PRS 由 8 个标准组成，每个标准有 2-4 个级别，每个标准的权重通过联合分析生成，该分析强制选择所有标准和级别之间的相对紧迫性。PRS 在审议小组中以及随后参与 PRS 测试的医生中，显示出风湿病学家和 PCP 之间的临床排名之间具有很强的相关性。
对于向风湿病学家转诊的所有范围，没有标准化的优先级设置标准。PRS 在小组成员中具有面值，并在与其他风湿病学家和 PCP 进行测试时提供了可接受的组内和组间可靠性。在其他临床医生和其他环境中的试点测试是合理的，也是在临床实践中使用的前提。
