Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa.
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa.
Acad Pediatr. 2018 May-Jun;18(4):409-417. doi: 10.1016/j.acap.2017.12.008. Epub 2017 Dec 23.
One barrier to timely access to outpatient pediatric subspecialty care is the complexity of scheduling processes. We evaluated the impact of implementing electronically transmitted referrals on subspecialty visit attendance.
Through collaboration with stakeholders, an electronically transmitted referral order system was designed, piloted, and implemented in 15 general pediatrics practices, with 24 additional practices serving as controls. We used statistical process control methods and difference-in-differences analysis to examine visits attended, appointments scheduled, appointment nonattendance, and referral volume. Electronically transmitted referrals then were expanded to all 39 practices. We surveyed referring pediatricians at all practices before and after implementation.
From April 2015 through September 2016 there were 33,485 referral orders across all practices (7770 before the pilot, 11,776 during the pilot, 13,939 after full implementation). At pilot practices, there was a significant and sustained improvement in subspecialty visits attended within 4 weeks of referral (10.9% to 20.0%; P < .001). Relative to control practices, pilot practices experienced an 8.6% improvement (P = .001). After implementation at control practices, rates of visits attended also improved but to a smaller degree: 11.8% to 14.7% (P < .001). In survey responses, referring pediatricians noted improved scheduling processes but had continued concerns with appointment availability and referral tracking.
While electronically transmitted referrals improved visit attendance after pediatric subspecialty referral, the sizable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to pediatric subspecialty care.
门诊儿科专科医疗服务及时性的一个障碍是预约流程的复杂性。我们评估了实施电子转诊对专科就诊出席率的影响。
通过与利益相关者合作，设计、试点并在 15 家普通儿科诊所实施了电子转诊订单系统，另外 24 家诊所作为对照。我们使用统计过程控制方法和差分分析来检查就诊、预约安排、预约不参加和转诊量。然后将电子转诊扩展到所有 39 家诊所。我们在实施前后调查了所有诊所的转诊医生。
从 2015 年 4 月至 2016 年 9 月，所有诊所共有 33485 份转诊单（试点前 7770 份，试点期间 11776 份，全面实施后 13939 份）。在试点诊所，转诊后 4 周内专科就诊率显著且持续提高（10.9%至 20.0%；P<0.001）。与对照诊所相比，试点诊所的就诊率提高了 8.6%（P=0.001）。在对照诊所实施后，就诊率也有所提高，但幅度较小：从 11.8%提高到 14.7%（P<0.001）。在调查回复中，转诊医生指出预约流程有所改善，但仍对预约可用性和转诊跟踪存在持续关注。
虽然电子转诊改善了儿科专科转诊后的就诊出席率，但仍有相当大比例的儿童未能就诊，对照组的效果较小，以及儿科医生的调查回复表明，需要进一步努力解决儿科专科医疗服务的障碍。
