Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Improving Quality of Referrals From Primary to Specialty Care in An Underserved Community
Greysen, Heather M., Gourley, Mark F.
Communication between the primary care provider (PCP) and specialist is important in the management of chronic rheumatic conditions and leads to improved patient care. Rapid referral to a rheumatologist and early treatment improves patient outcomes; however, inappropriate or excessive referrals to the specialist can strain clinic resources. Evidence suggests that distributing standardized guidelines for referral and providing education to primary care providers improves the referral process.
Thirty-six PCPs in 5 clinics in the Washington DC area who refer patients to an NIH community clinic received a standardized referral sheet and a 40 minute educational intervention about common rheumatic diseases, taught by a rheumatology physician and nurse practitioner. The standardized referral sheet included guidelines for when to refer a patient and what information should be included in the referral. Referral quality was assessed pre- and post-intervention and compared to a control group that did not receive the guidelines sheet or the intervention. Quality was assessed by means of a scoring system, ranging from 0 to 3, developed for this study.
0 = PCP did not provide clinical data nor direction; 1 = PCP provided direction and no clinical data or provided clinical data without direction; 2 = PCP provided direction and one piece of clinical data. 3 = PCP provided direction and more than one piece of clinical data. Scores of 01 are considered poor, and 2 to 3 are considered good. Direction is awarded for formulating a specific clinical question. Clinical data includes recent progress note, lab results, and x-rays. The scoring system was validated by 4 other rheumatologists in the practice. Statistical significance was calculated using a paired t-Test.
From June 2008June 2009, we analyzed referrals from each intervention clinic 3 months pre- and post-intervention. Control group referrals were gathered from September 2008February 2009. More than half (63%) of pre-intervention referrals were scored 01 (poor) compared with only 15% post-intervention. Most (85%) of post-intervention were scored 23 (good) compared with 37% of pre-intervention referrals. Referrals received after the intervention improved significantly (p< 0.05). The control group, without any intervention, sent primarily poor quality referrals; 72% were poor and 28% were good.
|Number of Referrals||0 or 1 = Poor||2 or 3 = Good|
|Control, n=58||42 (72%)||16 (28%)|
|Pre, n=30||19 (63%)||11 (37%)|
|Post, n=34||5 (15%)||29 (85%)|
Our results show that this standardized tool and intervention improved referral quality, which helps the specialist deliver better quality care. Poor referrals lead to long wait lists and delay in initiation of therapy. Others authors have found that a guidelines tool was inadequate without a personal interaction between the PCPs and the specialist. Our intervention sessions increased communication by opening up a dialog between primary and specialty care providers.
To cite this abstract, please use the following information:
Greysen, Heather M., Gourley, Mark F.; Improving Quality of Referrals From Primary to Specialty Care in An Underserved Community [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1867