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Improving referral activity on primary-secondary care interface using an electronic decision support system. | LitMetric

Improving referral activity on primary-secondary care interface using an electronic decision support system.

Int J Med Inform

Hospital of Rovereto, LHU APSS, Corso Verona, 4, 38068 Rovereto, Italy. Electronic address:

Published: December 2013

AI Article Synopsis

Article Abstract

Objective: Our main aim was to evaluate the ability of electronic feedback and of an electronic referral decision support system (ERSS) to enhance agreement between primary care physicians (PCPs) and specialists in priority assignment in clinics.

Method: 62 PCPs used a ranking system of waiting times based on different categories of clinical priority called 'Homogeneous Waiting Groups' (HWGs), which was also used by specialists to assign a priority category for each patient. From the year 2001, all PCPs had to use a paper-based manual (group 1); instead from 2008, specialists began to use a computer-based tool, whereby the priority category reassigned to each patient by specialists promptly appeared on PCPs' computers (group 2). During the course of 2010, the manual was incorporated in ERSS and was used by a subgroup of PCPs (group 3). Agreement between PCPs and specialists' priority assignments was evaluated by the kappa statistic.

Results: In group 1, the kappa statistic was 0.564 (95% CI=0.526-0.602); in group 2, the kappa statistic was 0.668 (95% CI=0.619-0.716); whereas in group 3 (that used ERSS) a very high kappa statistic emerged of 0.883 (95% CI=0.854-0.912). There was a significant difference in the proportion of agreement among the three groups (χ(2)=182.5, 2df, p<.0001). A significant difference in statistics was also observed in the proportion of priority levels used by PCPs over the years.

Conclusions: Our results emphasize the positive effect of feedback and ERSS for improving referral activity and agreement between PCPs and specialists.

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Source
http://dx.doi.org/10.1016/j.ijmedinf.2013.08.003DOI Listing

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