Knottnerus J A, Joosten J, Daams J
Department of General Practice, University of Limburg, Maastricht, The Netherlands.
Br J Gen Pract. 1990 May;40(334):178-81.
The quality of referrals of four general practitioners, two with high and two with average rates of referral to the department of internal medicine, was judged by an independent expert panel. The panel, consisting of two general practitioners and one specialist, reviewed a set of information about the referrals blindly and in random sequence. The same distribution of quality of referrals was found among the referrals of the two high referring general practitioners (n = 192) as among those of the general practitioners with average rates (n = 88); that is, 57% and 55% respectively, of the cases had clear medical indications for referral, while the data did not permit a conclusion in 15% and 10%, respectively, of the cases. Controlling for sex, age and status of the referral (first or repeat referral) did not alter the results. We conclude that using referral rates to judge referral quality is misleading. However, a blind and randomly performed panel review of referrals is a time consuming but feasible method of quality assessment.
一个独立专家小组对四位全科医生的转诊质量进行了评估，其中两位转诊至内科的比例较高，另外两位转诊比例为平均水平。该小组由两位全科医生和一位专科医生组成，他们以盲法和随机顺序审查了一组关于转诊的信息。在转诊比例较高的两位全科医生（n = 192）的转诊病例中，与转诊比例为平均水平的全科医生（n = 88）的转诊病例相比，发现了相同的转诊质量分布情况；也就是说，分别有57%和55%的病例有明确的转诊医学指征，而分别有15%和10%的病例数据无法得出结论。对性别、年龄和转诊状态（首次或重复转诊）进行控制并未改变结果。我们得出结论，使用转诊率来判断转诊质量具有误导性。然而，对转诊进行盲法和随机的小组审查是一种耗时但可行的质量评估方法。
