Referral patterns to a pediatric orthopedic clinic: Implications for education and practice
Referral patterns to a pediatric orthopedic clinic: Implications for education and practice
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DOI：
10.1542/peds.113.3.e163
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发表时间：
2004-03-01
期刊：
影响因子：
8
通讯作者：
Cucos, DR
中科院分区：
文献类型：
--
作者：
Reeder, BM;Lyne, ED;Cucos, DR
日益成为初级保健医学不可或缺的一部分。美国儿科学会(AAP)外科咨询小组最近发布了自愿指南，以确定应该转介给儿科专家而不是普通专家的诊断(儿科整形外科与普通整形外科手术)。考虑到儿科整形外科手术的人力和资源危机，我们认为这些指导方针在确定适当的转诊方面是有用的。这项研究的目的是比较初级保健儿科提供者认为通常需要转诊到AAP儿科专科医生转诊至儿科骨科专科医生的建议的诊断。在12个月期间，对儿科整形外科诊所的连续新转诊(n=286)进行了图表审查。收集了以下信息：1)转诊提供者的诊断，2)儿科骨科医生的诊断和治疗计划，3)转诊提供者的类型(例如，儿科医生、家庭医生、住院医生、医生助理)，以及4)患者年龄。将每个患者的转诊诊断、最终骨科诊断和治疗计划与美国儿科学会儿科专科医生转诊指南进行比较。术语“适当的”和“不适当的”分别用于区分符合和不符合AAP指南的诊断。这一分析表明，很大比例(64.7%)的确诊转诊病例与美国儿科学会推荐的儿科整形外科医生转诊指南不一致。此外，转诊诊断的假阳性率为23.8%(286例中有68例)。未经治疗或随访监测的病例假阳性率为32.8%(60/183)[(40例未治疗+20例监测不当)/(116例未治疗+67例监测总数)]假阳性。不适当的转介造成了对儿科整形外科资源的大量使用，从而延误了对其他更合适的患者的护理。很大比例的转介表明，要么缺乏基本的教科书知识，要么缺乏检查技能和适当的诊断工具，大量明确的诊断表明是正常的变种。
increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently published voluntary guidelines to establish diagnoses that should be referred to a pediatric specialist rather than a general specialist (pediatric orthopedic surgery vs general orthopedic surgery). Given the crisis in pediatric orthopedic surgery manpower and resources, we believe that these guidelines are useful in defining appropriate referrals. The purpose of this study was to compare diagnoses that primary care pediatric providers believe commonly need referral to the AAP Guidelines for Referral to Pediatric Specialists recommendations for referral to pediatric orthopedic specialists.Methods. A chart review of successive new referrals (n=286) to the pediatric orthopedic clinic during a 12-month period was conducted. The following information was collected: 1) diagnosis from referring provider, 2) diagnosis and treatment plan by the pediatric orthopedic surgeon, 3) type of referring provider (eg, pediatrician, family practitioner, resident physician, physician assistant), and 4) patient age. The referring diagnosis, final orthopedic diagnosis, and treatment plan for each patient was compared against the AAP Guidelines for Referral to Pediatric Specialists. The terms "appropriate" and "inappropriate" were used to differentiate those diagnoses that matched versus those that did not match the AAP Guidelines, respectively.Results. This analysis shows that a significant percentage (64.7%) of definitive diagnoses of referred cases were not consistent with the new AAP recommended guidelines for referral to pediatric orthopedic surgeons. In addition, a 23.8% (68 of 286) false-positive rate of referring diagnoses is noted. Cases that required no treatment or follow-up to monitor demonstrated a 32.8% (60 of 183) [(40 no treatment + 20 monitor inappropriate)/(116 no treatment + 67 monitor total)] false-positive rate.Conclusions. Inappropriate referrals create a large use of pediatric orthopedic resources, which delays care of other, more appropriate patients. A large proportion of referrals indicated either a lack of basic textbook knowledge or lack of examination skills and appropriate diagnostic tools as demonstrated by a high number of definitive diagnosis indicating normal variants.