Errors in completion of referrals among older urban adults in ambulatory care

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Rationale, aims and objectives Clinical care often requires referrals, but many referrals never result in completed evaluations. We determined the extent to which referral-based consultations were completed in a US medical institution. Factors associated with completion were identified. Method In a cross-sectional analysis, we analysed billing records and electronic and paper-based medical records for patients aged 65 years or older receiving health care between July 2000 and June 2002 in an integrated, urban, tax-supported medical institution on an academic campus. All referrals in ambulatory care, scheduling of consultation within 180 days, and completion were assessed. We conducted a multivariate survival analysis to identify factors associated with completion. Results We identified 6785 patients with encounters. Mean age was 72 years, and, of the participants, 66% were women, 55% were African-American and 32% were Medicaid eligible. Of the 81% with at least one primary-care visit in ambulatory care, 63% had at least one referral. About 8% of referrals required multiple orders before an appointment was scheduled. Among 7819 orders for specialty consultation in ambulatory care, 71% led to appointments, and 70% of appointments were kept (completed = 0.71*0.70 or 50%). Scheduling of consultations varied (12% to 90%) by specialty. Medicare, singular orders, location of referral and lack of hospitalization were independently significantly associated with scheduling of appointments. Conclusions Among older adults studied, half of medical specialty referrals were not completed. Multiple process errors, including missing information, misguided referrals and faulty communications, likely contribute to these results. Information systems offer important opportunities to improve the referrals process.

Original languageEnglish
Pages (from-to)76-81
Number of pages6
JournalJournal of Evaluation in Clinical Practice
Volume16
Issue number1
DOIs
StatePublished - Feb 2010

Fingerprint

Ambulatory Care
Referral and Consultation
Appointments and Schedules
Medicaid
Survival Analysis
Medicare
Information Systems
African Americans
Medical Records
Primary Health Care
Hospitalization
Multivariate Analysis
Cross-Sectional Studies
Communication
Medicine

Keywords

  • Geriatrics
  • Medical errors
  • Primary care
  • Referral and consultation
  • Scheduling

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy

Cite this

Errors in completion of referrals among older urban adults in ambulatory care. / Weiner, Michael; Perkins, Anthony J.; Callahan, Christopher.

In: Journal of Evaluation in Clinical Practice, Vol. 16, No. 1, 02.2010, p. 76-81.

Research output: Contribution to journalArticle

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abstract = "Rationale, aims and objectives Clinical care often requires referrals, but many referrals never result in completed evaluations. We determined the extent to which referral-based consultations were completed in a US medical institution. Factors associated with completion were identified. Method In a cross-sectional analysis, we analysed billing records and electronic and paper-based medical records for patients aged 65 years or older receiving health care between July 2000 and June 2002 in an integrated, urban, tax-supported medical institution on an academic campus. All referrals in ambulatory care, scheduling of consultation within 180 days, and completion were assessed. We conducted a multivariate survival analysis to identify factors associated with completion. Results We identified 6785 patients with encounters. Mean age was 72 years, and, of the participants, 66{\%} were women, 55{\%} were African-American and 32{\%} were Medicaid eligible. Of the 81{\%} with at least one primary-care visit in ambulatory care, 63{\%} had at least one referral. About 8{\%} of referrals required multiple orders before an appointment was scheduled. Among 7819 orders for specialty consultation in ambulatory care, 71{\%} led to appointments, and 70{\%} of appointments were kept (completed = 0.71*0.70 or 50{\%}). Scheduling of consultations varied (12{\%} to 90{\%}) by specialty. Medicare, singular orders, location of referral and lack of hospitalization were independently significantly associated with scheduling of appointments. Conclusions Among older adults studied, half of medical specialty referrals were not completed. Multiple process errors, including missing information, misguided referrals and faulty communications, likely contribute to these results. Information systems offer important opportunities to improve the referrals process.",
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