BACKGROUND: Improving health care will require more effective guideline implementation and redesign of delivery processes and systems. @entity1 referral for specialty care is a key component of health system function that needs to be improved. @entity1643 care is a widely documented example of the need for improvement. An @entity615 program was developed using process improvement methods. Proactively managing referrals for specialty care-a departure from traditional referral processes-played a critical role in implementing the program. METHODS: Program components included guidelines for care, defined provider roles, uniform service coding, provider and @entity1 education, pre-appointment specialty referral management, and monitoring of management processes. To evaluate program performance, system back @entity158 visits were compared before, during, and after implementation of referral management. A case series study was performed on 581 consecutive @entity1 with @entity1643 or @entity614 referred for consultative spine care between April 1998 and March 1999. RESULTS: A shift of care was accomplished for @entity615 from spine orthopedists to primary physicians and for @entity615 from spine orthopedists to medical specialists. More than 95% of initial assignments were accurate. Seventy-six percent of surveyed @entity615 @entity1 improved, and 90% were highly satisfied with the referral management process. This program has saved an estimated  400,000 per year in manpower cost and has reduced specialty service billings by 20%. DISCUSSION: Pre-appointment referral management offers an approach for improving guideline implementation, access to specialty services, and the effectiveness of care for complex health problems. It deserves broader study and adoption.

Implementing guidelines for XXXX : a critical role for pre-appointment management of specialty referrals.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Patient'] @entity1643 :: ('MESH:D017116', 'Disease') :: ['Low back pain', 'low back pain'] @entity615 :: ('MESH:D001416', 'Disease') :: ['acute back pain', 'interdisciplinary systemwide back pain', 'chronic back pain'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain'] @entity614 :: ('MESH:D011843', 'Disease') :: ['lumbar radiculopathy']
@entity1643 :: (MESH:D017116,Disease) :: ['interdisciplinary care of low back pain']
