From: Performance measures of the specialty referral process: a systematic review of the literature

Domain | Sub-domains | # Metrics | Metric Example |
---|---|---|---|

Evaluation of Need for Specialty Care (n = 14) | Referral Source | 14 | Proportion of self-referred visits [38] |

Referral Decision | 0 | ||

Referral Initiation (n = 73) | Reason for referral | 4 | Proportion of referrals for advice on diagnosis and treatment [3] |

Specialist selection | 27 | Proportion of PCPs who referred at patient request [39] | |

Referral rate | 42 | # Referrals to a specialist per 100 PCP visits [40] | |

Entry into Specialty Care (n = 53) | Attendance | 7 | Proportion of referred patients who attended first specialty visit [41] |

Accessibility | 46 | Total # providers per 100,000 people per state [42] | |

Coordination (n = 60) | Communication | 48 | Proportion of specialist reports by letter or e-mail [43] |

Integration of care | 17 | Proportion of PCPs who received feedback from a specialist [43] | |

Referral Type (n = 3) | Consultation | 3 | Proportion of referrals for procedural consultation [44] |

Co-management | 3 | Proportion of referrals for co-management with shared care [44] | |

Clinical Tasks (n = 19) | Problem recognition | 10 | Proportion of letters including a patient's condition [45] |

Diagnosis | 18 | Proportion of letters including a patient's diagnosis [45] | |

Treatment | 17 | Proportion of letters including treatment recommendation [45] | |

Reassessment | 12 | Proportion of letters including follow-up arrangements [45] | |

Resource Use (n = 13) | Services | 12 | Primary and specialty visits per patient per 30 days [46] |

Costs | 13 | Total annual specialty expenditures [47] | |

Quality (n = 57) | Appropriateness | 13 | Proportion of patients who received an unnecessary referral [48] |

Effectiveness | 4 | Proportion of PCPs who adhered to a specialists' recommendations [49] | |

Efficiency | 1 | Proportion of PCPs who believed a specialist was minimizing costs [50] | |

Equity | 0 | ||

Patient-centeredness | 8 | Proportion of patients who thought that specialty care was helpful[51] | |

Referral satisfaction | 21 | Proportion of patients who were satisfied with specialty care [52] | |

Safety | 0 | ||

Timeliness | 23 | Average length of time spent for a specialty visit [53] | |

Outcomes (n = 9) | Health status | 3 | Change in depression score on Hopkins Symptom Checklist [54] |

Mortality | 2 | Proportion of surviving patients per year [55] | |

Functional status | 3 | Change in score on Pain Interference Scale [56] | |

Unintended Consequences | 0 |