Practical Health Co-operation - The Impact of a Referral Template on Quality of Health Care

Quality of Health Care Clinical Trial

Official title:

Practical Health Co-operation - a Randomised Controlled Intervention Study. The Impact of a Referral Template on Quality of Care and Health Care Co-operation Between Primary and Secondary Care

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01470963
• Other study ID #: HST1026-11
• Status: Completed
• Phase: N/A
• First received: September 5, 2011
• Last updated: July 10, 2014
• Start date: September 2011
• Est. completion date: January 2014

Study information

• Verified date: July 2014
• Source: University Hospital of North Norway
• Contact: n/a
• Is FDA regulated: No
• Health authority: Norway: Regional Ethics Commitee
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to examine whether the implementation of a referral template will increase quality of health care delivered and the quality of health care co-operation. The investigators intent to implement a referral template, at the level of the general practitioner (GP), for the referral of patients within 4 separate diagnostic groups:

• dyspepsia/upper GI symptoms

• colonic cancer investigation/lower GI symptoms

• chronic obstructive pulmonary disease (COPD)

• chest pain

Local GP clinics will be randomised to use the referral template or to use standard referral practice. Using a predefined set of quality criteria the investigators will score the process of care in each patient, and compare intervention and control groups. In addition other criteria will be collected and compared between the two groups, e.g.

• time to diagnosis/treatment

• quality of referral

• more appropriate referrals

• patient satisfaction (as measured by a questionnaire)

The investigators hypothesize that the implementation of a referral template will lead to a measurable increase in the quality of health care delivered.

Description:

There is a continuous work to improve the quality of health care delivered to an individual patient, both in primary and secondary care. The referral from primary to secondary care represents a key component in the communication between the levels of care, and therefore an important tool in developing the quality of care. There has been many attempts at improving the quality of referrals, but less work has been focussed on the consequence of such improvement on quality of health care. This study is designed as a randomised controlled intervention study where we intent to implement a referral templates, at the level of the general practitioner (GP). These templates will be for the referral of patients within 4 separate diagnostic groups:

• dyspepsia/upper GI symptoms

• colonic cancer investigation/lower GI symptoms

• chronic obstructive pulmonary disease (COPD)

• chest pain

Following the course of the health care process we will assess the quality of the care process by using predefined quality of care criteria, together with patient satisfaction (as measured by questionnaire) and other health process indicators.

Our primary hypothesis is that the implementation of a referral template in the communication between primary and secondary care, will lead to a measurable increase in the quality of health care delivered.

Secondary hypothesis include:

• the use of a referral template in the communication between the GP and secondary care, will lead to better patient satisfaction.

• the use of a referral template in the communication between the GP and secondary care, will lead to a change (up or down) in the amount of patients defined as being in need of prioritisation (as defined pr. national guidelines for prioritisation in health care)

• the use of a referral template in the communication between the GP and secondary care, will lead to a measurable referral quality improvement

• the use of a referral template in the communication between the GP and secondary care, will increase the "appropriateness" of the referrals

Recruitment information / eligibility

• Status: Completed
• Enrollment: 500
• Est. completion date: January 2014
• Est. primary completion date: January 2014
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• referral to medical department of University Hospital of North Norway, Harstad

Exclusion Criteria:

• children (< 18 years of age)

• patients with reduced capacity to consent

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Quality of Health Care
• Referral

Intervention

Other:
• Implementation of referral template
Implementation of referral template at the GP office

Locations

Country	Name	City	State
Norway	Medical department - University Hospital of North Norway Harstad	Harstad

Sponsors (2)

Lead Sponsor	Collaborator
University Hospital of North Norway	University of Tromso

Country where clinical trial is conducted

Norway, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Collated quality indicator score	Based on treatment guidelines and international quality assessment tools we have developed quality indicators score sets for each of the 4 diagnostic groups in the study. The scores will be compared between intervention and control GP offices to assess the effect of the referral template.	The care period for each patient (approx. 3 weeks up to 1 year)	No
Secondary	Improved referral quality	The investigators will evaluate each referral against the referral template, and then compare between intervention and control groups.	The care period for each patient (approx. 3 weeks up to 1 year)	No
Secondary	Waiting time from referral to appointment		The care period for each patient (approx. 3 weeks up to 1 year)	No
Secondary	Time from referral to initiation of treatment	Compare the time from referral to initiation of treatment/"decision no treatment" necessary between intervention and control groups	The care period for each patient (approx. 3 weeks up to 1 year)	No
Secondary	Percentage of patients seen within investigation deadline	Compare the number of patients in the two groups seen within the limit set in national prioritisation guidelines	Assessed at end of study - approx 2 years	No
Secondary	Number of patients designated with investigation deadline	Compare the number of patients in the intervention vs. control group that were designated with a investigation deadline according to national prioritisation guidelines	Assessed at end of study - approx 2 years	No
Secondary	Patient satisfaction	Patient satisfaction as measured by self report questionnaire	The care period for each patient (approx. 3 weeks up to 1 year)	No
Secondary	Positive predictive value of referral	Compare the percentage of referrals between the intervention and control groups which have lead to; a diagnostic clarification, or; a histological diagnosis, or; a change in medical management	The care period for each patient (approx. 3 weeks up to 1 year)	No
Secondary	Number of appointments needed for diagnostic clarification	Compare the number of appointments needed to clarify diagnosis between intervention and control groups	The care period for each patient (approx. 3 weeks up to 1 year)	No