Coordination of specialty referrals and physician satisfaction with referral care
Coordination of specialty referrals and physician satisfaction with referral care
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DOI：
10.1001/archpedi.154.5.499
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发表时间：
2000-05-01
影响因子：
--
通讯作者：
Starfield, B
中科院分区：
文献类型：
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作者：
Forrest, CB;Glade, GB;Starfield, B
目的：描述医生如何协调专科转诊的患者护理，并检查这些活动对转诊医生对患者接受的专科护理的满意度和转诊完成的影响。设计和方法：前瞻性研究的转诊连续样本（N = 963）来自122儿科医生的办公室在85实践国家实践为基础的研究网络。数据来源包括转诊时完成的医生调查（有效率，99%）和3个月后进行的医生调查和病历审查（有效率，85%）。转诊完成定义为收到专家的转诊结果的书面沟通。结果：儿科医生预约专科医生的比例为39.3%，向专科医生发送患者信息的比例为50.8%。与那些没有任何活动发生的转诊相比，那些儿科医生安排了预约并与专家沟通的转诊完成的调整几率增加了3倍。任何类型的专家反馈都显著提高了转诊医生的满意度，其中包括电话和信件反馈的转诊医生满意度最高。专家信函中显著提高医生对信函质量评价的要素包括患者病史、未来护理建议、随访安排和管理护理计划；只有纳入病人护理管理计划与转诊医生的整体满意度显著相关。结论：转诊医师与专科医师之间更好的协调可以提高医师对专科护理的满意度，提高转诊成功率。通过初级保健医生和专科医生之间更好的沟通和协作，可以改善转诊过程。
Objectives: To describe how physicians coordinate patient care for specialty referrals and to examine the effects of these activities on referring physicians' satisfaction with the specialty care their patients receive and referral completion.Design and Methods: Prospective study of a consecutive sample of referrals (N = 963) made from the offices of 122 pediatricians in 85 practices in a national practice-based research network. Data sources included a physician survey completed when the referral was made (response rate, 99%) and a physician survey and medical record review conducted 3 months later (response rate, 85%). Referral completion was defined as receipt of written communication of referral results from the specialist.Results: Pediatricians scheduled appointments with specialists for 39.3% and sent patient information to specialists for 50.8% of referrals. The adjusted odds of referral completion were increased 3-fold for those referrals for which the pediatrician scheduled the appointment and communicated with the specialist compared with those for which neither activity occurred. Referring physicians' satisfaction ratings were significantly increased by any type of specialist feedback and were highest for referrals involving specialist feedback by both telephone and letter. Elements of Specialists' letters that significantly increased physician ratings of letter quality included presence of patient history, suggestions for future care, follow-up arrangements, and plans for comanaging care; only the inclusion of plans for comanaging patient care was significantly related to the referring physicians' overall satisfaction.Conclusions: Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion. Improvements in the referral process may be achieved through better communication and collaboration between primary care physicians and specialists.