The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial
Background: The assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care. Methods: A cluster r...
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BioMed Central
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Online Access: | http://hdl.handle.net/10852/62315 http://urn.nb.no/URN:NBN:no-64902 https://doi.org/10.1186/s12913-017-2127-1 |
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ftoslouniv:oai:www.duo.uio.no:10852/62315 2023-05-15T17:39:24+02:00 The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial Wåhlberg, Henrik Valle, Per Christian Malm, Siri Hovde, Øistein Broderstad, Ann Ragnhild 2017-06-01T09:45:52Z http://hdl.handle.net/10852/62315 http://urn.nb.no/URN:NBN:no-64902 https://doi.org/10.1186/s12913-017-2127-1 EN eng BioMed Central http://urn.nb.no/URN:NBN:no-64902 Wåhlberg, Henrik Valle, Per Christian Malm, Siri Hovde, Øistein Broderstad, Ann Ragnhild . The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial. BMC Health Services Research. 2017, 17:177, 1-13 http://hdl.handle.net/10852/62315 1473398 info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=BMC Health Services Research&rft.volume=17:177&rft.spage=1&rft.date=2017 BMC Health Services Research 17:177 1 13 http://dx.doi.org/10.1186/s12913-017-2127-1 URN:NBN:no-64902 Fulltext https://www.duo.uio.no/bitstream/handle/10852/62315/1/article21878.pdf Attribution 4.0 International https://creativecommons.org/licenses/by/4.0/ CC-BY 1472-6963 Journal article Tidsskriftartikkel Peer reviewed PublishedVersion 2017 ftoslouniv https://doi.org/10.1186/s12913-017-2127-1 2020-06-21T08:51:27Z Background: The assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care. Methods: A cluster randomized trial with the general practitioner surgery as the clustering unit was performed. Fourteen surgeries in the area surrounding the University Hospital of North Norway Harstad were randomized stratified by town versus countryside location. The intervention consisted of implementing referral templates for new referrals in four clinical areas: dyspepsia; suspected colorectal cancer; chest pain; and confirmed or suspected chronic obstructive pulmonary disease. The control group followed standard referral practice. Quality of treatment pathway as assessed by newly developed quality indicators was used as main outcome. Secondary outcomes included subjective quality assessment, positive predictive value of referral and adequacy of prioritization. Assessment of outcomes was done at the individual level. The patients, hospital doctors and outcome assessors were blinded to the intervention status. Results: A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. From the multilevel regression model the effect of the intervention on the quality indicator score was insignificant at 1.80% (95% CI, −1.46 to 5.06, p = 0.280). No significant differences between the intervention and the control groups were seen in the secondary outcomes. Active use of the referral intervention was low, estimated at approximately 50%. There was also wide variation in outcome scoring between the different assessors. Conclusions: In this study no measurable effect on quality of care or prioritization was revealed after implementation of referral templates at the general practitioner/hospital interface. The results were hindered by a limited uptake of the intervention at GP surgeries and inconsistencies in outcome assessment. Article in Journal/Newspaper North Norway Universitet i Oslo: Digitale utgivelser ved UiO (DUO) Norway BMC Health Services Research 17 1 |
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Open Polar |
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Universitet i Oslo: Digitale utgivelser ved UiO (DUO) |
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ftoslouniv |
language |
English |
description |
Background: The assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care. Methods: A cluster randomized trial with the general practitioner surgery as the clustering unit was performed. Fourteen surgeries in the area surrounding the University Hospital of North Norway Harstad were randomized stratified by town versus countryside location. The intervention consisted of implementing referral templates for new referrals in four clinical areas: dyspepsia; suspected colorectal cancer; chest pain; and confirmed or suspected chronic obstructive pulmonary disease. The control group followed standard referral practice. Quality of treatment pathway as assessed by newly developed quality indicators was used as main outcome. Secondary outcomes included subjective quality assessment, positive predictive value of referral and adequacy of prioritization. Assessment of outcomes was done at the individual level. The patients, hospital doctors and outcome assessors were blinded to the intervention status. Results: A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. From the multilevel regression model the effect of the intervention on the quality indicator score was insignificant at 1.80% (95% CI, −1.46 to 5.06, p = 0.280). No significant differences between the intervention and the control groups were seen in the secondary outcomes. Active use of the referral intervention was low, estimated at approximately 50%. There was also wide variation in outcome scoring between the different assessors. Conclusions: In this study no measurable effect on quality of care or prioritization was revealed after implementation of referral templates at the general practitioner/hospital interface. The results were hindered by a limited uptake of the intervention at GP surgeries and inconsistencies in outcome assessment. |
format |
Article in Journal/Newspaper |
author |
Wåhlberg, Henrik Valle, Per Christian Malm, Siri Hovde, Øistein Broderstad, Ann Ragnhild |
spellingShingle |
Wåhlberg, Henrik Valle, Per Christian Malm, Siri Hovde, Øistein Broderstad, Ann Ragnhild The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial |
author_facet |
Wåhlberg, Henrik Valle, Per Christian Malm, Siri Hovde, Øistein Broderstad, Ann Ragnhild |
author_sort |
Wåhlberg, Henrik |
title |
The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial |
title_short |
The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial |
title_full |
The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial |
title_fullStr |
The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial |
title_full_unstemmed |
The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial |
title_sort |
effect of referral templates on out-patient quality of care in a hospital setting: a cluster randomized controlled trial |
publisher |
BioMed Central |
publishDate |
2017 |
url |
http://hdl.handle.net/10852/62315 http://urn.nb.no/URN:NBN:no-64902 https://doi.org/10.1186/s12913-017-2127-1 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
North Norway |
genre_facet |
North Norway |
op_source |
1472-6963 |
op_relation |
http://urn.nb.no/URN:NBN:no-64902 Wåhlberg, Henrik Valle, Per Christian Malm, Siri Hovde, Øistein Broderstad, Ann Ragnhild . The effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trial. BMC Health Services Research. 2017, 17:177, 1-13 http://hdl.handle.net/10852/62315 1473398 info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=BMC Health Services Research&rft.volume=17:177&rft.spage=1&rft.date=2017 BMC Health Services Research 17:177 1 13 http://dx.doi.org/10.1186/s12913-017-2127-1 URN:NBN:no-64902 Fulltext https://www.duo.uio.no/bitstream/handle/10852/62315/1/article21878.pdf |
op_rights |
Attribution 4.0 International https://creativecommons.org/licenses/by/4.0/ |
op_rightsnorm |
CC-BY |
op_doi |
https://doi.org/10.1186/s12913-017-2127-1 |
container_title |
BMC Health Services Research |
container_volume |
17 |
container_issue |
1 |
_version_ |
1766140172194283520 |