title: Improving Appropriate Access to Care With Central Referral and Triage in Rheumatology.
abstract: To evaluate the short-term and long-term impact of a centralized system for the intake and triage of rheumatology referrals on access to care and referral quality.
  
  
  
  An innovative central referral process, the Central Referral and Triage in Rheumatology (CReATe Rheum) program, was implemented in 2006, serving a referral base of 2 million people. Referrals are received in a central office, triaged by trained nurses, and assigned to the next available appointment on a prioritized basis. To evaluate the short-term impact, we compared wait times, duplicate referrals, and no-shows from a pre-implementation practice audit to a 2-year post-implementation evaluation (January 2007 to December 2008). Rheumatologists also assessed the quality and completeness of the referral information and accuracy of the urgency category assigned during triage. We evaluated the long-term impact by tracking referral volume, wait times, and rheumatologist manpower each year until December, 2013.
  
  
  
  During the first 2 years, wait-time variability between rheumatologists decreased, and wait times were reduced for moderate and urgent referrals. CReATe Rheum improved the quality of referral information and eliminated duplicate referrals. The urgency of the referral was assigned correctly in 90% of referrals. Over the long term, CReATe Rheum maintained short wait times for more urgent patients despite a growing number of referrals and a stable number of rheumatologists.
  
  
  
  A centralized system for the intake and triage of rheumatology referrals improved referral quality, reduced system inefficiencies, and effectively managed wait times on a prioritized basis for a large referral population.
authors.affiliation: University of Calgary and Cumming School of Medicine, Calgary, Alberta, and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Glen S
authors.initials: GS
authors.lastname: Hazlewood
authors.affiliation: University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada. sgbarr@ucalgary.ca.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Barr
authors.affiliation: Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Elena
authors.initials: E
authors.lastname: Lopatina
authors.affiliation: University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
authors.affiliation: Alberta Health Services, Calgary, Alberta, Canada.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Lupton
authors.affiliation: University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Marvin J
authors.initials: MJ
authors.lastname: Fritzler
authors.affiliation: University of Calgary and Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Dianne P
authors.initials: DP
authors.lastname: Mosher
authors.affiliation: University of Calgary, Calgary, Alberta, Canada.
authors.forename: Whitney A
authors.initials: WA
authors.lastname: Steber
authors.affiliation: University of Calgary, Calgary, Alberta, Canada.
authors.forename: Liam
authors.initials: L
authors.lastname: Martin
mesh_terms: D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015397:Program Evaluation; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000175:diagnosis; D012219:Rheumatology / Q000379:methods*; D013997:Time Factors; D014218:Triage / Q000379:methods*; D014850:Waiting Lists