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转诊管理“网关”对转诊信质量的影响:回顾性时间序列交叉分析。

Impact of a referral management "gateway" on the quality of referral letters; a retrospective time series cross sectional review.

机构信息

Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Brighton BN1 9PH, UK.

出版信息

BMC Health Serv Res. 2013 Aug 14;13:310. doi: 10.1186/1472-6963-13-310.

Abstract

BACKGROUND

Referral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care.This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters.

METHODS

Retrospective, time-series, cross-sectional review involving 47 general practices in one primary care trust (PCT) in South-East England. Comparison of a random sample of referral letters at baseline (n = 301) and after seven months of referral management (n = 280). Letters were assessed for inclusion of four core pieces of information which are used locally to monitor referral quality (blood pressure, body mass index, past medical history, medication history) and against research-based quality criteria for referral letters (provision of clinical information and clarity of reason for referral).

RESULTS

Following introduction of the RMC, the proportion of letters containing each of the core items increased compared to baseline. Statistically significant increases in the recording of 'past medical history' (from 71% to 84%, p < 0.001) and 'medication history' (78% to 87%, p = 0.006) were observed. Forty four percent of letters met the research-based quality criteria at baseline but there was no significant change in quality of referral letters judged on these criteria across the two time periods.

CONCLUSION

Introduction of RMC has improved the inclusion of past medical history and medication history in referral letters, but not other measures of quality. In approximately half of letters there remains room for further improvement.

摘要

背景

为了促进初级保健向二级保健的转诊途径,转诊管理中心(RMC)旨在通过提高转诊质量并缓解有限的二级保健服务压力,同时又不影响患者护理,从而实现这一目标。本研究旨在评估引入包括分诊和反馈在内的 RMC 是否能提高择期门诊转诊信的质量。

方法

这是一项在英格兰东南部的一个初级保健信托基金(PCT)中的 47 家普通实践进行的回顾性、时间序列、横断面研究。在基线(n=301)和转诊管理 7 个月后(n=280),对随机抽样的转诊信进行比较。这些信件是根据当地用来监测转诊质量的四个核心信息(血压、体重指数、既往病史、用药史)和基于研究的转诊信质量标准(提供临床信息和转诊原因的清晰度)进行评估的。

结果

在引入 RMC 后,与基线相比,包含每个核心项目的信件比例增加了。记录“既往病史”(从 71%增加到 84%,p<0.001)和“用药史”(从 78%增加到 87%,p=0.006)的比例显著增加。基线时,有 44%的信件符合基于研究的质量标准,但在这两个时间段内,根据这些标准判断的转诊信质量没有显著变化。

结论

引入 RMC 提高了转诊信中既往病史和用药史的记录,但其他质量措施没有改善。在大约一半的信件中,仍有进一步改进的空间。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8157/3844396/12801d4e94ad/1472-6963-13-310-1.jpg

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