Green Gabrielle, Flores Roxana, Barragan Noel C, Gonzalez Karla, Kuo Tony
Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010, USA.
The Wellness Center at the Historic General Hospital, 1200 N. State St, Los Angeles, CA 90012, USA.
Transl Behav Med. 2025 Jan 16;15(1). doi: 10.1093/tbm/ibae072.
Emerging evidence suggests that bi-directional communication and referral pathways, when employed strategically, can lead to favorable health outcomes by connecting patients with complex, multi-faceted health and social needs to appropriate services and resources. However, despite these benefits, patient acceptance of referrals via these pathways remains suboptimal. In this study, we describe individual and clinical factors associated with patient acceptance of these referrals. We extracted individual-level demographic and clinical data for patients referred primarily from a large safety-net health system to a multi-purpose resource hub co-located on the campus of its largest hospital, for the period October 2019 to June 2023. Descriptive statistics, Chi-square analyses, and multinomial regression modeling were performed to examine these data. Of 1865 patients in the study sample, 54.2% accepted a referral, 27.4% were lost to follow-up, and 18.4% declined. Most patients who accepted referrals were female (67.1%), Latino (81.5%), and had hypertension and/or prediabetes or diabetes (84.1%). In modeling analyses, those who accepted referrals tended to be female, and were referred from primary care clinics; many were referred for multiple service/resource categories. We found associations between patient acceptance of referrals and gender and source of referral. Drawing upon these results as well as experience implementing these systems, we propose several practical strategies for increasing successful referrals, including identifying and addressing barriers for patients who declined or were lost to follow-up; using standardized screening tools to routinely assess for multi-faceted health and social needs; increasing provider awareness about the benefits and functioning of these pathways; and monitoring progress so mid-course adjustments can be made when necessary.
新出现的证据表明，双向沟通和转诊途径若能得到战略性运用，可通过将有复杂、多方面健康和社会需求的患者与适当的服务及资源相连接，从而带来良好的健康结果。然而，尽管有这些益处，但患者通过这些途径接受转诊的情况仍不尽人意。在本研究中，我们描述了与患者接受这些转诊相关的个体和临床因素。我们提取了2019年10月至2023年6月期间主要从一个大型安全网医疗系统转诊至位于其最大医院校园内的多用途资源中心的患者的个体层面人口统计学和临床数据。进行了描述性统计、卡方分析和多项回归建模以检查这些数据。在研究样本的1865名患者中，54.2%接受了转诊，27.4%失访，18.4%拒绝了转诊。大多数接受转诊的患者为女性（67.1%）、拉丁裔（81.5%），患有高血压和/或糖尿病前期或糖尿病（84.1%）。在建模分析中，接受转诊的患者往往为女性，且来自初级保健诊所；许多患者被转诊至多个服务/资源类别。我们发现患者接受转诊与性别和转诊来源之间存在关联。基于这些结果以及实施这些系统的经验，我们提出了几种提高成功转诊的实用策略，包括识别并解决拒绝或失访患者的障碍；使用标准化筛查工具定期评估多方面的健康和社会需求；提高医疗服务提供者对这些途径的益处和运作方式的认识；以及监测进展情况，以便在必要时进行中期调整。
