Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass; Harvard Medical School, Boston, Mass.
Division of General Pediatrics, Boston Children's Hospital, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Boston, Mass.
Acad Pediatr. 2018 Sep-Oct;18(7):797-804. doi: 10.1016/j.acap.2018.03.010. Epub 2018 Apr 3.
The quality of children's health is compromised by poor care coordination between primary care providers (PCPs) and specialists. Our objective was to determine how an electronic consultation and referral system impacts referral patterns and PCP-specialist communication.
The primary care clinic at Boston Children's Hospital piloted an electronic referral and consultation system with the neurology and gastroenterology departments from April 1, 2014, to October 31, 2016. PCPs completed an electronic consult form, and if needed, specialists replied with advice or facilitated expedited appointments. Specialist response times, referral rates, wait times, and completion rates for specialty visits were tracked. PCPs and specialists also completed a survey to evaluate feasibility and satisfaction.
A total of 82 PCPs placed 510 consults during the pilot period. Specialists responded to 88% of requests within 3 business days. Eighteen percent of specialty visits were deferred and 21% were expedited. Wait times for specialty appointments to both departments significantly decreased, from 48 to 34 days (P < .001), and completion rates improved from 58% to 70% (P < .01), but referral volumes remained stable (25 per month to 23 per month; P = .29). Most PCPs said the Shared Care system facilitated better communication with specialists (89%) and enabled them to provide superior patient care (92%). Specialists reported that the system required a minimal amount of time and enabled them to educate PCPs and triage referrals.
Implementation of an electronic referral and consultation system was feasible and provided timely access to specialty care, but did not affect referral volume. This system could serve as a model for other health care organizations and specialties.
初级保健提供者（PCP）与专家之间的医疗协调不善，影响了儿童的健康质量。我们的目的是确定电子咨询和转介系统如何影响转介模式和 PCP 与专家的沟通。
波士顿儿童医院的初级保健诊所于 2014 年 4 月 1 日至 2016 年 10 月 31 日试点电子转介和咨询系统，与神经科和胃肠病科合作。PCP 填写电子咨询表，如果需要，专家会回复建议或协助加急预约。跟踪专家的回复时间、转介率、等待时间和专科就诊的完成率。PCP 和专家还完成了一项调查，以评估可行性和满意度。
在试点期间，共有 82 名 PCP 提出了 510 次咨询。专家在 3 个工作日内回复了 88%的请求。18%的专科就诊被推迟，21%的专科就诊被加急。两个科室的专科预约等待时间明显缩短，从 48 天缩短至 34 天（P<0.001），完成率从 58%提高至 70%（P<0.01），但转介量保持稳定（每月 25 次降至每月 23 次；P=0.29）。大多数 PCP 表示 Shared Care 系统促进了与专家更好的沟通（89%），并使他们能够提供更优质的患者护理（92%）。专家报告称，该系统需要的时间很少，使他们能够教育 PCP 并对转介进行分类。
电子转介和咨询系统的实施是可行的，能够及时获得专科护理，但并未影响转介量。该系统可以作为其他医疗保健组织和专业的典范。
