The product and process of referral

Bal, Roland; Mastboom, Femke; Spiers, Han Paul; Rutten, H.J.T.

doi:10.1016/j.ijmedinf.2006.05.033

Cited by 22 publications

(8 citation statements)

References 9 publications

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“…Following the re- organization of referral process, the use of standards and guidelines has increased. It is also furthering the integration of primary and secondary domains ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

2015

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Background:around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment’s and services. In order to respond these challenges and reduction of health system’s transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes.Methods:relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby’s index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria.Results:we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services.Conclusion:each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner.

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“…Following the re- organization of referral process, the use of standards and guidelines has increased. It is also furthering the integration of primary and secondary domains ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

2015

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“…We extracted all referral letters from medical files, including those sent by mail or fax, and those sent digitally using ZorgDomein (Care Domain) (Bal, Mastboom, Spiers, & Rutten, 2007). The…”

Section: Data Collection Of Medical Filesmentioning

confidence: 99%

“…This system has become widely used in the Netherlands over the last decade. The precise format differs slightly by the reason for referral and by department, as all formats are composed at a regional level by collaboration between specialists and GPs (Bal et al, 2007).…”

Section: Data Collection Of Medical Filesmentioning

confidence: 99%

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Correspondence between primary and secondary care about patients with cancer: A qualitative mixed-methods analysis

et al. 2018

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Cancer care is complex and involves many different healthcare providers, especially during diagnosis and initial treatment, and it has been reported that both general practitioners and oncology specialists experience difficulties with interdisciplinary communication. The aim of this qualitative study was to explore information sharing between primary and secondary care for patients with lung, breast or colorectal cancer. A qualitative content analysis of 50 medical files (419 documents) was performed, which identified 70 correspondence-related items. Six main topics were identified in most referral letters from primary to secondary care, but it was particularly notable that highly relevant information regarding the past medical history was often mixed with less relevant information. To lesser extents, the same held true for the medication list and presenting history. In the letters from specialists, nine topics were identified in most letters. Although information about actual treatment was always present, only limited detail, if any, was given about the intent of the treatment (curative or palliative) or the treatment alternatives. Interviews with nine healthcare providers confirmed these issues. These findings indicate that neither the initial referral nor the specialist correspondence is tailored to the needs of the recipient.

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“…Despite recommendations that referral coordination should be improved, [1,3,17] Available: http://www.biomedcentral.com/1472-6963/9/62, [18] the healthcare literature sheds little light on which elements of coordination should be targeted. Although a recent measurement framework of coordinated care is a start,[19] it does not identify the specific tools ( e.g ., routines, plans, schedules) and processes healthcare providers use to collectively and effectively transition patient care from primary to secondary care setting and vice versa [20,21].…”

Section: Introductionmentioning

confidence: 99%

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

Hysong

Esquivel²,

Sittig

et al. 2011

Implementation Sci

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BackgroundSuccessful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs) (i.e., e-referrals), lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system.MethodsWe conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA) medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process.ResultsFour themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported.ConclusionsDespite facilitating information transfer between PCPs and subspecialists, e-referrals remain prone to coordination breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.

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The product and process of referral

Cited by 22 publications

References 9 publications

E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

Correspondence between primary and secondary care about patients with cancer: A qualitative mixed-methods analysis

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

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