Evaluation of specialist referrals at a rural health care clinic

Abstract

Purpose Transition to a value‐based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience. Data sources A 6‐month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6‐month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%. Conclusions The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals. Implications for practice The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements.

Quality assessment of orthopedic surgery referral request letters from primary care consultation: Evaluation of a Spanish healthcare area

“…It is very difficult to justify these records. Some studies have also reported a higher rate of unnecessary rural patient PC referrals,[ 11 ] perhaps as a result of the higher use of public and non-hospital based consultations by the rural population,[ 12 13 ] but it also could be due to a lack of communication and/or coordination among PC practitioners. [ 14 ]…”

"Jaundice Clinical Manifestation and Pathophysiology: A Review Article"

“…One or more substances such as enzymes (glucoronidase), 3 alpha, beta and 20 pregnanediol in breast milk although to be possible cause of breast milk jaundice. Jaundice is influenced by several factors, namely dehydration, weight loss after birth, bleeding, cephalohaematoma, contusions, babies in mothers with diabetes, acidosis, apixia, and gastrointestinal obstruction [4].…”

Referências médicas evitáveis em unidade de saúde de Porto Alegre

“…Em alguns utiliza-se a "população consultadora" do território do serviço de APS, 14 em outros o número de consultas no serviço. 15,16 Alguns estudos 14,15,16,17,18 realizaram uma análise dos padrões desse referenciamento, porém, no que se refere à realidade brasileira, 19 pouco foi explorado (Quadro 1). A oferta de especialistas focais no Sistema Único de Saúde (SUS) é escassa e a alocação de recursos deve ser otimizada.…”