Abstract
BackgroundPerformance of specialty referrals is coming under scrutiny, but a lack of identifiable measures impedes measurement efforts. The objective of this study was to systematically review the literature to identify published measures that assess specialty referrals.MethodsWe performed a systematic review of the literature for measures of specialty referral. Searches were made of MEDLINE and HealthSTAR databases, references of eligible papers, and citations provided by content experts. Measures were eligible if they were published from January 1973 to June 2009, reported on validity and/or reliability of the measure, and were applicable to Organization for Economic Cooperation and Development healthcare systems. We classified measures according to a conceptual framework, which underwent content validation with an expert panel.ResultsWe identified 2,964 potentially eligible papers. After abstract and full-text review, we selected 214 papers containing 244 measures. Most measures were applied in adults (57%), assessed structural elements of the referral process (60%), and collected data via survey (62%). Measures were classified into non-mutually exclusive domains: need for specialty care (N = 14), referral initiation (N = 73), entry into specialty care (N = 53), coordination (N = 60), referral type (N = 3), clinical tasks (N = 19), resource use (N = 13), quality (N = 57), and outcomes (N = 9).ConclusionsPublished measures are available to assess the specialty referral process, although some domains are limited. Because many of these measures have been not been extensively validated in general populations, assess limited aspects of the referral process, and require new data collection, their applicability and preference in assessment of the specialty referral process is needed.
Highlights
Performance of specialty referrals is coming under scrutiny, but a lack of identifiable measures impedes measurement efforts
Responsibilities for primary care clinicians in this role include ensuring that the health needs of patients are met, services are integrated across providers and over time, and patients are linked with relevant community resources [15,16,17]
Consultation regarding the referral decision may be made with a referral source such as a primary care clinician or emergency medicine clinician
Summary
Performance of specialty referrals is coming under scrutiny, but a lack of identifiable measures impedes measurement efforts. A clear consensus on the availability and role of specialists is lacking, which likely contributes to the marked variation in use of specialty care across regions and countries [4]. Responsibilities for primary care clinicians in this role include ensuring that the health needs of patients are met, services are integrated across providers and over time, and patients are linked with relevant community resources [15,16,17]. The benefits of these primary care tasks have been established empirically [13,18]
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