de Marco P, Dain C, Lockwood T, Roland M
Department of General Practice, University of Manchester, Rusholme Health Centre.
BMJ. 1993 Dec 4;307(6917):1465-6. doi: 10.1136/bmj.307.6917.1465.
To determine general practitioners' responses to and explanations for variation in rates of referral to hospital and how feedback of data on rates of referral could be used to facilitate practices in auditing their own referral behaviour.
Visits by audit facilitators to general practices after feedback of details of rates of referral to hospital derived from annual reports in general practice.
92 general practices in East Anglia.
General practitioners judged that access to specialist care, the individual skill of general practitioners, patient demand, and fear of litigation were major determinants of referral behaviour. Because there was widespread scepticism about the accuracy of the data on which the feedback was based and because there is no clear relation between rates of referral and quality of care, it was extremely difficult to encourage doctors to use the feedback as a basis for auditing their own hospital referrals.
If general practitioners are to contribute meaningfully to monitoring future changes in referral patterns it will be essential to develop reliable information systems in which doctors have confidence. Furthermore, audits need to be based on analysis of clinical cases rather than on rates of referral.
确定全科医生对转诊至医院的比例差异的反应及解释，以及如何利用转诊比例数据的反馈来促进他们对自身转诊行为的审核。
在反馈从全科医疗年度报告中得出的转诊至医院的比例细节后，审核促进者走访全科诊所。
东安格利亚的92家全科诊所。
全科医生认为获得专科护理的机会、全科医生的个人技能、患者需求以及对诉讼的担忧是转诊行为的主要决定因素。由于对反馈所依据的数据准确性普遍持怀疑态度，且转诊比例与护理质量之间没有明确关系，因此极难鼓励医生将反馈作为审核自身医院转诊行为的依据。
如果全科医生要对监测未来转诊模式的变化做出有意义的贡献，那么开发可靠的信息系统并让医生对其有信心至关重要。此外，审核需要基于对临床病例的分析，而非转诊比例。
