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dc.contributor.authorWåhlberg, Henrik
dc.contributor.authorValle, Per Christian
dc.contributor.authorMalm, Siri
dc.contributor.authorHovde, Øistein
dc.contributor.authorBroderstad, Ann Ragnhild
dc.date.accessioned2018-05-16T12:00:17Z
dc.date.available2018-05-16T12:00:17Z
dc.date.created2017-06-01T09:45:52Z
dc.date.issued2017
dc.identifier.citationBMC Health Services Research. 2017, 17:177 1-13.nb_NO
dc.identifier.issn1472-6963
dc.identifier.urihttp://hdl.handle.net/11250/2498410
dc.description.abstractBackground The assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care. Methods A cluster randomized trial with the general practitioner surgery as the clustering unit was performed. Fourteen surgeries in the area surrounding the University Hospital of North Norway Harstad were randomized stratified by town versus countryside location. The intervention consisted of implementing referral templates for new referrals in four clinical areas: dyspepsia; suspected colorectal cancer; chest pain; and confirmed or suspected chronic obstructive pulmonary disease. The control group followed standard referral practice. Quality of treatment pathway as assessed by newly developed quality indicators was used as main outcome. Secondary outcomes included subjective quality assessment, positive predictive value of referral and adequacy of prioritization. Assessment of outcomes was done at the individual level. The patients, hospital doctors and outcome assessors were blinded to the intervention status. Results A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. From the multilevel regression model the effect of the intervention on the quality indicator score was insignificant at 1.80% (95% CI, −1.46 to 5.06, p = 0.280). No significant differences between the intervention and the control groups were seen in the secondary outcomes. Active use of the referral intervention was low, estimated at approximately 50%. There was also wide variation in outcome scoring between the different assessors. Conclusions In this study no measurable effect on quality of care or prioritization was revealed after implementation of referral templates at the general practitioner/hospital interface. The results were hindered by a limited uptake of the intervention at GP surgeries and inconsistencies in outcome assessment.nb_NO
dc.description.sponsorshipFunding This work was funded by a research grant from the Northern Norway Regional Health Authority (Helse Nord RHF) with grant number HST1026-11. The funding body had no role in the design of the study, collection and analysis of the data or writing of the manuscript.nb_NO
dc.language.isoengnb_NO
dc.relation.urihttps://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2127-1
dc.rightsNavngivelse 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/deed.no*
dc.subjectQuality of carenb_NO
dc.subjectReferralnb_NO
dc.subjectCare cooperationnb_NO
dc.titleThe effect of referral templates on out-patient quality of care in a hospital setting: A cluster randomized controlled trialnb_NO
dc.typeJournal articlenb_NO
dc.typePeer reviewednb_NO
dc.description.versionpublishedVersionnb_NO
dc.rights.holder© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.nb_NO
dc.source.pagenumber1-13nb_NO
dc.source.volume17:177nb_NO
dc.source.journalBMC Health Services Researchnb_NO
dc.identifier.doi10.1186/s12913-017-2127-1
dc.identifier.cristin1473398
cristin.unitcode1991,3,0,0
cristin.unitnameDiv Gjøvik
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode2


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