1. A web-based generalist-specialist system to improve scheduling of outpatient specialty consultations in an academic center.
- Author
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Weiner, Michael, Hoyek, Georges El, Wang, Lynnette, Dexter, Paul R., Zerr, Ann D., Perkins, Anthony J., James, Felgrace, Juneja, Rattan, and El Hoyek, Georges
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OUTPATIENT medical care , *MEDICAL errors , *MEDICAL practice , *MEDICAL education , *MEDICAL care , *INTERNET standards , *MEDICINE , *RESEARCH , *FERRANS & Powers Quality of Life Index , *ACADEMIC medical centers , *RESEARCH methodology , *EVALUATION research , *MEDICAL cooperation , *COMPARATIVE studies , *MEDICAL referrals , *RESEARCH funding , *MEDICAL appointments , *OUTPATIENT services in hospitals ,MEDICAL standards - Abstract
Background: Failed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.Objective: We determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.Design: Staggered implementation of a quality-improvement project, with comparison of intervention and control groups.Participants: Patients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.Interventions: Faxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.Measurements: We compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.Main Results: Among 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.Conclusions: With a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services. [ABSTRACT FROM AUTHOR]- Published
- 2009
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