Ryan Bridget L, Shadd Joshua, Maddocks Heather, Stewart Moira, Thind Amardeep, Terry Amanda L
Western University.
McMaster University.
J Innov Health Inform. 2017 Nov 17;24(4):888. doi: 10.14236/jhi.v24i4.888.
A referral from a family physician (FP) to a specialist is an inflection point in the patient journey, with potential implications for clinical outcomes and health policy. Primary care electronic medical record (EMR) databases offer opportunities to examine referral patterns. Until recently, software techniques were not available to model these kinds of multi-level count data. OBJECTIVE: To establish methodology for determining referral rates from FPs to medical specialists using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) EMR database. METHOD: Retrospective cohort study, mixed effects and multi-level negative binomial regression modelling with 87,258 eligible patients between 2007 and 2012. Mean referrals compared by patient sex, age, chronic conditions, FP visits, and urban/rural practice location. Proportion of variance in referral rates attributable to the patient and practice levels. RESULTS: On average, males had 0.26, and females 0.31 referrals in a 12-month period. Referrals were significantly higher for females, increased with age, FP visits, and number of chronic conditions (p<.0001). Overall, 14% of the variance in referrals could be attributed to the practice level, and 86% to patient level characteristics. CONCLUSIONS: Both patient and practice characteristics influenced referral patterns. The methodologic insights gained from this study have relevance to future studies on many research questions that utilize count data, both within primary care and broader health services research. The utility of the CPCSSN database will continue to increase in tandem with data quality improvements, providing a valuable resource to study Canadian referral patterns over time.
家庭医生（FP）将患者转诊给专科医生是患者就医过程中的一个转折点，对临床结果和卫生政策可能产生影响。基层医疗电子病历（EMR）数据库为研究转诊模式提供了机会。直到最近，还没有可用的软件技术来对这类多层次计数数据进行建模。目的：利用加拿大基层医疗哨点监测网络（CPCSSN）的电子病历数据库，建立确定家庭医生向医学专科医生转诊率的方法。方法：回顾性队列研究，采用混合效应和多层次负二项回归模型，对2007年至2012年间87258名符合条件的患者进行研究。按患者性别、年龄、慢性病、家庭医生就诊次数以及城市/农村执业地点比较平均转诊次数。转诊率差异中可归因于患者和执业水平的比例。结果：平均而言，男性在12个月内有0.26次转诊，女性有0.31次转诊。女性的转诊率明显更高，且随年龄、家庭医生就诊次数和慢性病数量增加（p<0.0001）。总体而言，转诊差异的14%可归因于执业水平，86%可归因于患者水平特征。结论：患者和执业特征均影响转诊模式。本研究获得的方法学见解与未来许多利用计数数据的研究问题相关，这些问题既涉及基层医疗，也涉及更广泛的卫生服务研究。随着数据质量的提高，CPCSSN数据库的效用将不断增加，为长期研究加拿大的转诊模式提供宝贵资源。
