Eskeland Sigrun Losada, Rueegg Corina Silvia, Brunborg Cathrine, Aabakken Lars, de Lange Thomas
Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, PO Box 800, Drammen, Norway.
Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, Oslo, Norway.
Int J Qual Health Care. 2018 Jul 1;30(6):450-456. doi: 10.1093/intqhc/mzy057.
Investigate whether gastroenterologists rate the quality of referral letters higher if electronic dynamic checklist items are added to a standard free-text referral letter. Assess how this affects the gastroenterologists' assessment of the patient's need for healthcare and the agreement between their assessments.
Randomized vignette study.
Norwegian primary gastroenterology services.
Thirty-two Norwegian gastroenterologists.
Between June 2015 and January 2016, participants were recruited through an open invitation to all members of the Norwegian Society of Gastroenterology. They were asked to rate 16 referral letters (vignettes) in a web interface: eight letters in free text following a general template and eight letters based on a general referral template combined with diagnosis-specific checklist items. The study was completed in two subsequent rounds ≥3 months apart.
Quality of referral letters assessed on a rating scale from 0 to 10. Agreement in the referral assessment and accuracy of the selection of correct preliminary diagnosis and appropriate work-up.
The mean quality assesses on the rating scale was 7.0 (95% confidence interval [CI] 6.8-7.2) for all letters combined (n = 511), 6.5(CI 6.2-6.8) for the free-text referrals (n = 256) and 7.5(CI 7.3-7.7) for the checklist referrals (n = 255) (P < 0.001, paired t-test). No difference was observed in the triage of the patients, but fewer gastroenterologists felt the need to collect additional information about the patients in the checklist group.
Checklist items may ease the assessment of the referrals for gastroenterologists. We were not able to show that checklists significantly influence the management of patients.
调查在标准的自由文本转诊信中添加电子动态检查表项目后，胃肠病专家对转诊信质量的评分是否更高。评估这如何影响胃肠病专家对患者医疗需求的评估以及他们评估之间的一致性。
随机 vignette 研究。
挪威初级胃肠病服务机构。
32 名挪威胃肠病专家。
2015 年 6 月至 2016 年 1 月期间，通过向挪威胃肠病学会所有成员发出公开邀请招募参与者。要求他们在网络界面中对 16 封转诊信（vignettes）进行评分：8 封遵循通用模板的自由文本信和 8 封基于通用转诊模板并结合特定诊断检查表项目的信。该研究分两个后续轮次完成，两轮间隔≥3 个月。
转诊信质量采用 0 至 10 的评分量表进行评估。转诊评估的一致性以及正确初步诊断和适当检查选择的准确性。
所有信件（n = 511）综合评分量表上的平均质量评分为 7.0（95%置信区间[CI]6.8 - 7.2），自由文本转诊信（n = 256）为 6.5（CI 6.2 - 6.8），检查表转诊信（n = 255）为 7.5（CI 7.3 - 7.7）（P < 0.001，配对 t 检验）。在患者分诊方面未观察到差异，但检查表组中感觉需要收集患者额外信息的胃肠病专家较少。
检查表项目可能会简化胃肠病专家对转诊的评估。我们未能表明检查表会显著影响患者的管理。
