title: Improving referral activity on primary-secondary care interface using an electronic decision support system.
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.
  
  
  METHODS
  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.
authors.affiliation: Hospital of Rovereto, LHU APSS, Corso Verona, 4, 38068 Rovereto, Italy. Electronic address: giuliano.mariotti@apss.tn.it.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Mariotti
authors.forename: Maria
authors.initials: M
authors.lastname: Gentilini
authors.forename: Valter
authors.initials: V
authors.lastname: Dapor
mesh_terms: D020000:Decision Support Systems, Clinical / Q000592:standards*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D063127:Secondary Health Care / Q000592:standards*; D013038:Specialization
keywords: Decision support systems; Management; Primary care; Referral and consultation; Waiting list