NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
J Gen Intern Med. 2022 Oct;37(13):3444-3452. doi: 10.1007/s11606-022-07574-6. Epub 2022 Apr 19.
Physician referrals are a critical step in directing patients to high-quality specialists. Despite efforts to encourage referrals to high-volume hospitals, many patients receive treatment at low-volume centers with worse outcomes. We aimed to determine the most important factors considered by referring providers when selecting specialists for their patients through a systematic review of medical and surgical literature.
PubMed and Embase were searched from January 2000 to July 2021 using terms related to referrals, specialty, surgery, primary care, and decision-making. We included survey and interview studies reporting the factors considered by healthcare providers as they refer patients to specialists in the USA. Studies were screened by two independent reviewers. Quality was assessed using the CASP Checklist. A qualitative thematic analysis was performed to synthesize common decision factors across studies.
We screened 1,972 abstracts and identified 7 studies for inclusion, reporting on 1,575 providers. Thematic analysis showed that referring providers consider factors related to the specialist's clinical expertise (skill, training, outcomes, and assessments), interactions between the patient and specialist (prior experience, rapport, location, scheduling, preference, and insurance), and interactions between the referring physician and specialist (personal relationships, communication, reputation, reciprocity, and practice or system affiliation). Notably, studies did not describe how providers assess clinical or technical skills.
Referring providers rely on subjective factors and assessments to evaluate quality when selecting a specialist. There may be a role for guidelines and objective measures of quality to inform the choice of specialist by referring providers.
医生转介是指导患者就诊高质量专家的关键步骤。尽管已经努力鼓励向高容量医院转介，但许多患者仍在低容量中心接受治疗，结果更差。我们旨在通过对医学和外科文献的系统回顾，确定转介医生在为患者选择专家时考虑的最重要因素。
使用与转介、专业、手术、初级保健和决策相关的术语，从 2000 年 1 月至 2021 年 7 月在 PubMed 和 Embase 上进行了搜索。我们纳入了报告美国医疗保健提供者在向专家转介患者时考虑因素的调查和访谈研究。研究由两名独立审查员进行筛选。使用 CASP 清单评估质量。通过定性主题分析对研究中常见的决策因素进行综合。
我们筛选了 1972 篇摘要，确定了 7 项符合纳入标准的研究，共报告了 1575 名提供者。主题分析表明，转介提供者考虑与专家临床专业知识相关的因素（技能、培训、结果和评估）、患者与专家之间的互动（既往经验、融洽度、位置、日程安排、偏好和保险）以及转介医生与专家之间的互动（人际关系、沟通、声誉、互惠和实践或系统隶属关系）。值得注意的是，这些研究并未描述提供者如何评估临床或技术技能。
转介提供者在选择专家时依赖主观因素和评估来评估质量。可能需要指南和客观质量措施来为转介提供者选择专家提供信息。
