Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts; Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
Endocr Pract. 2023 Aug;29(8):623-628. doi: 10.1016/j.eprac.2023.05.010. Epub 2023 May 30.
Endocrinology referrals frequently lack important clinical information, which may increase the risk of inefficiency and adverse outcomes. This quality improvement project aimed to improve the completeness of new referrals by utilizing structured referral templates for common endocrine conditions at a large Veterans Health Administration medical center. Our target was of at least a 30% improvement in referral completeness for each condition after the intervention.
Electronic structured referral templates were designed utilizing existing resources and input from primary care providers and endocrinologists. Essential elements were identified and included in the templates. We conducted a retrospective chart review to compare referrals for 125 patients referred between January 1, 2021 and September 1, 2021 (preintervention) and 125 patients referred between October 1, 2021 and September 30, 2022 (postintervention). Each referral was rated using a scoring system derived from the criteria in the data abstraction tool formulated by the investigators.
On average, preintervention referrals included 52% of the essential elements and postintervention referrals included 93%. Improvements in referral scores for each condition all met the prespecified 30% improvement target. The greatest improvement was for the element "type of visit preference." A separate analysis excluding that element showed an average improvement from 64% of essential elements preintervention to 92% postintervention.
Structured referral templates, designed with the input of primary care providers and endocrinologists and embedded into an electronic referral system, can improve the availability of essential information and increase the quality of referrals. Future work should examine the effect of structured referral templates on efficiency, specialist experience, patient experience of care, and clinical outcomes.
内分泌学转诊通常缺乏重要的临床信息，这可能增加效率低下和不良后果的风险。本质量改进项目旨在通过在大型退伍军人健康管理医疗中心为常见内分泌疾病使用结构化转诊模板来提高新转诊的完整性。我们的目标是，干预后，每种情况下的转诊完整率至少提高 30%。
利用现有资源以及初级保健提供者和内分泌学家的投入，设计了电子结构化转诊模板。确定了基本要素并将其纳入模板中。我们进行了回顾性图表审查，比较了 2021 年 1 月 1 日至 2021 年 9 月 1 日（干预前）和 2021 年 10 月 1 日至 2022 年 9 月 30 日（干预后）转诊的 125 名患者的转诊。使用源自调查员制定的数据提取工具标准的评分系统对每个转诊进行评分。
平均而言，干预前的转诊包含 52%的基本要素，而干预后的转诊包含 93%。每种情况下转诊评分的改善均达到了规定的 30%的改善目标。最大的改善是在“就诊偏好类型”要素上。不包括该要素的单独分析显示，干预前基本要素的平均改善率为 64%，干预后为 92%。
在初级保健提供者和内分泌学家的投入下设计并嵌入电子转诊系统的结构化转诊模板可以提高基本信息的可用性，并提高转诊质量。未来的工作应研究结构化转诊模板对效率、专家经验、患者护理体验和临床结果的影响。
