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

NCT ID: NCT01470963

Last Updated: 2014-07-11

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 500 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-09-30
• Study Completion Date: 2014-01-31

Brief 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.

Detailed 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

Conditions

Referral; Quality of Health Care

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Referral template

Implementation of the referral templates at the GP office

Group Type: EXPERIMENTAL

Implementation of referral template

Intervention Type: OTHER

Implementation of referral template at the GP office

Control

Normal referral pattern

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Implementation of referral template

Implementation of referral template at the GP office

Intervention Type: OTHER

Eligibility Criteria

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

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Tromso

OTHER

Sponsor Role: collaborator

University Hospital of North Norway

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Ann Ragnhild Broderstad, Dr. med

Role: PRINCIPAL_INVESTIGATOR

University Hospital of North Norway

Locations

Medical department - University Hospital of North Norway Harstad

Harstad, , Norway

Countries

Norway

References

Wahlberg H, Valle PC, Malm S, Hovde O, Broderstad AR. The effect of referral templates on out-patient quality of care in a hospital setting: a cluster randomized controlled trial. BMC Health Serv Res. 2017 Mar 7;17(1):177. doi: 10.1186/s12913-017-2127-1.

Reference Type: DERIVED

PMID: 28270128 (View on PubMed)

Wahlberg H, Braaten T, Broderstad AR. Impact of referral templates on patient experience of the referral and care process: a cluster randomised trial. BMJ Open. 2016 Oct 24;6(10):e011651. doi: 10.1136/bmjopen-2016-011651.

Reference Type: DERIVED

PMID: 27797992 (View on PubMed)

Wahlberg H, Valle PC, Malm S, Broderstad AR. Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial. BMC Health Serv Res. 2015 Aug 29;15:353. doi: 10.1186/s12913-015-1017-7.

Reference Type: DERIVED

PMID: 26318734 (View on PubMed)

Wahlberg H, Valle PC, Malm S, Broderstad AR. Practical health co-operation - the impact of a referral template on quality of care and health care co-operation: study protocol for a cluster randomized controlled trial. Trials. 2013 Jan 7;14:7. doi: 10.1186/1745-6215-14-7.

Reference Type: DERIVED

PMID: 23295103 (View on PubMed)

Other Identifiers

HST1026-11

Identifier Type: -

Identifier Source: org_study_id