转诊信质量对及时获得专业精神卫生保健的影响：对患者分诊可靠性的定量研究。

The impact of referral letter quality on timely access to specialised mental health care: a quantitative study of the reliability of patient triage.

机构信息

Department of Research and Innovation, Helse Fonna Health Trust, Haugesund, Norway.

Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

出版信息

BMC Health Serv Res. 2022 Jun 2;22(1):735. doi: 10.1186/s12913-022-08139-3.

DOI:10.1186/s12913-022-08139-3

PMID:35655302

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9161652/

Abstract

BACKGROUND

Patients referred to specialised mental health care are usually triaged based on referral information provided by general practitioners. However, knowledge about this system's ability to ensure timely access to and equity in specialised mental health care is limited. We aimed to investigate to the degree to which patient triage, based on referral letter information, corresponds to triage based on a hospital specialist's consultation with the patient, and whether the degree of correspondence is affected by the quality of the referral letter.

METHODS

We gathered information from three specialised mental health centres in Norway regarding patients that were referred and offered health care (N = 264). Data consisted of triage decisions for each patient (i.e., the hospital specialist's assessment of maximum acceptable waiting time), which were determined on the basis of a) referral information and b) meeting the patient. Referral letter quality was evaluated using the Quality of Referral information-Mental Health checklist. The reliability of priority setting and the impact of referral letter quality on this measure were investigated using descriptive analyses, binary logistic regression and Nadaraya-Watson kernel regression.

RESULTS

In 143 (54%) cases, the triage decision based on referral information corresponded with the decision based on patient consultation. In 70 (27%) cases, the urgency of need for treatment was underestimated when based on referral information compared with that based on information from patient consultation. Referral letter quality could not explain the differences between the two triage decisions. However, when a cut-off value of 7 on the Quality of Referral information-Mental Health scale was used, low-quality letters were found more frequently among patients whose urgency of need was underestimated, compared with those whose need was overestimated.

CONCLUSIONS

Deciding the urgency of patient need for specialised mental health care based on referral information is a reliable system in many situations. However, the possibility of under- and overestimation is present, implying risks to patient safety and inappropriate use of resources. Improving the content of referral letters does not appear to reduce this risk when the letters are of acceptable quality.

TRIAL REGISTRATION

NCT01374035 .

摘要

背景

通常根据全科医生提供的转诊信息对转介至专门心理健康护理的患者进行分诊。然而，关于该系统确保及时获得和公平获得专门心理健康护理的能力的知识有限。我们旨在研究基于转诊信信息的患者分诊与基于医院专家与患者咨询的分诊之间的对应程度，以及对应程度是否受到转诊信质量的影响。

方法

我们从挪威的三个专门的心理健康中心收集了有关被转诊和提供医疗保健的患者的信息（N=264）。数据包括每个患者的分诊决策（即医院专家对最大可接受等待时间的评估），这些决策是基于 a）转诊信息和 b）与患者见面来确定的。使用“心理健康转诊信息质量清单”评估转诊信质量。使用描述性分析、二元逻辑回归和纳达雅-沃森核回归来研究优先级设置的可靠性以及转诊信质量对该措施的影响。

结果

在 143 例（54%）病例中，基于转诊信息的分诊决策与基于患者咨询的决策相对应。在 70 例（27%）病例中，与基于患者咨询的信息相比，基于转诊信息评估的治疗需求紧迫性被低估。转诊信质量无法解释两种分诊决策之间的差异。然而，当使用“心理健康转诊信息质量清单”上的 7 分作为截止值时，发现与那些需求被高估的患者相比，需求被低估的患者中更频繁地出现低质量的信件。