Practical health co-operation - the impact of a referral template on quality of care and health care co-operation: study protocol for a cluster randomized controlled trial

Abstract

BackgroundThe referral letter plays a key role both in the communication between primary and secondary care, and in the quality of the health care process. Many studies have attempted to evaluate and improve the quality of these referral letters, but few have assessed the impact of their quality on the health care delivered to each patient.MethodsA cluster randomized trial, with the general practitioner office as the unit of randomization, has been designed to evaluate the effect of a referral intervention on the quality of health care delivered. Referral templates have been developed covering four diagnostic groups: dyspepsia, suspected colonic malignancy, chest pain, and chronic obstructive pulmonary disease. Of the 14 general practitioner offices primarily served by University Hospital of North Norway Harstad, seven were randomized to the intervention group. The primary outcome is a collated quality indicator score developed for each diagnostic group. Secondary outcomes include: quality of the referral, health process outcome such as waiting times, and adequacy of prioritization. In addition, information on patient satisfaction will be collected using self-report questionnaires. Outcome data will be collected on the individual level and analyzed by random effects linear regression.DiscussionPoor communication between primary and secondary care can lead to inappropriate investigations and erroneous prioritization. This study’s primary hypothesis is that the use of a referral template in this communication will lead to a measurable increase in the quality of health care delivered.Trial registrationThis trial has been registered at ClinicalTrials.gov. The trial registration number is NCT01470963

Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

“… 48 Deficient interdisciplinary communication across the continuum of care may explain a part of problems experienced with patient referrals and prioritization along with delayed treatments. 49 …”

Impact of referral templates on patient experience of the referral and care process: a cluster randomised trial

“…An additional weakness was the lack of a sound analytical plan proposed in the methods paper 11. To ensure transparency, the analysis presented in this paper is therefore simple and based on single-question assessment.…”

“…No correction for clustering was made as the estimated ICC was very low (shown below). Aggregation of scores was postulated in the methods paper,11 but discarded as a main outcome as properties of the questionnaire, with a ‘not applicable’ answering category, are not easily suitable for such an approach. However, to assess the effect of clustering, a sum of scores from the GS-PEQ part of the questionnaire was calculated and a multilevel regression model was built with the GS-PEQ score from the questionnaire as the dependent variable.…”

“…This article presents the patient experience aspect of a cluster randomised study evaluating the effect of the implementation of referral templates for four diagnostic groups—dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease (COPD)—in the patient referral pathway 11. Previously, we have shown that the referral templates led to increased referral quality,12 and the effect on the main outcome, quality of care at the hospital, is in publication.…”

European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy – a quality control study

“…Some studies have suggested guidelines for the specific content of referral letters within different medical specialties (72)(73)(74)(75) and some have shown a beneficial effect of referral templates/form letters on the quality of referral letters (76)(77)(78)(79)(80). Structured templates have also been effective for improving documentation in other medical records, particularly in reports from examinations/procedures (81)(82)(83)(84).…”