title: Leveraging an electronic referral system to build a medical neighborhood.
abstract: BACKGROUND
  Electronic referral and consultation systems are gaining popularity, but their contribution to the patient centered medical home-neighborhood framework of coordinated care delivery is not clear. We examined how specialists leverage an electronic referral and consultation system to deliver specialty care, identified determinants of high-quality electronic specialist communication and measured the impact of feedback to specialists on communication quality.
  
  
  METHODS
  Referral patterns were identified for 19 specialties using eReferral in the San Francisco public health care delivery system. Primary care provider (PCP) ratings of the quality (helpfulness and educational value) of consultative communication were measured. Using logistic regression, we identified determinants of high-quality specialist communication during pre-consultative exchange or virtual co-management. Predictors included: specialty and reviewer type, referral volume, percent of referrals never scheduled and time spent by reviewers on eReferral. A pre-post analysis examined the impact of feedback on communication quality.
  
  
  RESULTS
  The percentage of referrals immediately scheduled (27.2-82.8%) and never scheduled (7.7-59.3%) varied by specialty, with medical reviewers (vs. surgical and women׳s health) and physician reviewers (vs. nurse practitioners) scheduling fewer referrals immediately (p<0.001). Prevalence of high-quality communication was 71%, impacted by referral volume (adjusted odds ratio=0.78, 95%CI 0.68-0.88 for each additional 1000 referrals/year) and time spent per referral (1.18, 1.04-1.35 for each additional 3min).
  
  
  CONCLUSIONS
  Specialists can use electronic referral and consultation systems to enhance specialty care delivery with consultative communication that is highly rated by PCPs.
  
  
  CONCLUSIONS
  These data can inform the structure and functionality of future electronic consultation systems to maximize care coordination.
  
  
  METHODS
  III.
authors.affiliation: Division of Nephrology at San Francisco General Hospital, University of California, Box 1341, San Francisco, USA; Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: Delphine.tuot@ucsf.edu.
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Tuot
authors.affiliation: Division of Endocrinology at San Francisco General Hospital, University of California, Box 0862, San Francisco, USA; Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: emurphy@medsfgh.ucsf.edu.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Murphy
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, Box 0560, San Francisco, USA. Electronic address: Charles.McCulloch@ucsf.edu.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: leedsk@medsfgh.ucsf.edu.
authors.forename: Kiren
authors.initials: K
authors.lastname: Leeds
authors.affiliation: Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: Evelyn.chen@ucsf.edu.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Chan
authors.affiliation: Division of General Internal Medicine at San Francisco General Hospital, University of California, Box 1364, San Francisco, USA; Center for Innovation in Access and Quality, San Francisco General Hospital, Box 1364, San Francisco, USA. Electronic address: Achen@medsfgh.ucsf.edu.
authors.forename: Alice Hm
authors.initials: AH
authors.lastname: Chen
mesh_terms: D003142:Communication; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008511:Medicine; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000639:trends; D012495:San Francisco
keywords: Electronic consultation; Medical neighborhood; Primary–specialty interface