title: Interventions to Improve the Quality of Outpatient Specialty Referral Requests: A Systematic Review.
abstract: Requests for outpatient specialty consultations occur frequently but often are of poor quality because of incompleteness. The authors searched bibliographic databases, trial registries, and references during October 2014 for studies evaluating interventions to improve the quality of outpatient specialty referral requests compared to usual practice. Two reviewers independently extracted data and assessed quality. Findings were qualitatively summarized for completeness of information relayed in a referral request within naturally emerging intervention categories. Of 3495 articles screened, 11 were eligible. All 3 studies evaluating software-based interventions found statistically significant improvements. Among 4 studies evaluating template/pro forma interventions, completeness was uniformly improved but with variable or unreported statistical significance. Of 4 studies evaluating educational interventions, 2 favored the intervention and 2 found no difference. One study evaluating referral management was negative. Current evidence for improving referral request quality is strongest for software-based interventions and templates, although methodological quality varied and findings may be setting specific.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH Dartmouth-Hitchcock Medical Center, Lebanon, NH Chase.D.Hendrickson@Hitchcock.org.
authors.forename: Chase D
authors.initials: CD
authors.lastname: Hendrickson
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Lacourciere
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH Dartmouth-Hitchcock Medical Center, Lebanon, NH Concord Hospital, Concord, NH.
authors.forename: Cole A
authors.initials: CA
authors.lastname: Zanetti
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH Tuck School of Business at Dartmouth, Hanover, NH.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Donaldson
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH Veteran's Affairs Medical Center, White River Junction, VT Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Larson
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008511:Medicine / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data
keywords: consultation; improvement; quality; referral; template