Clinical trial NCT01470963: Practical Health Co-operation - The Impact of a Referral Template on Quality of Health Care
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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Referral
Quality of Health Care
Keywords: Referral
Quality of Health Care
Lead sponsor: University Hospital of North Norway
Sponsor class: OTHER
Collaborators: name: University of Tromso
First posted: 2011-11-11
Enrollment: 500
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

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

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

Primary outcomes:
measure: Collated quality indicator score
timeFrame: The care period for each patient (approx. 3 weeks up to 1 year)
Secondary outcomes:
measure: Improved referral quality
timeFrame: The care period for each patient (approx. 3 weeks up to 1 year)
measure: Waiting time from referral to appointment
timeFrame: The care period for each patient (approx. 3 weeks up to 1 year)
measure: Time from referral to initiation of treatment
timeFrame: The care period for each patient (approx. 3 weeks up to 1 year)
measure: Percentage of patients seen within investigation deadline
timeFrame: Assessed at end of study - approx 2 years
measure: Number of patients designated with investigation deadline
timeFrame: Assessed at end of study - approx 2 years
measure: Patient satisfaction
timeFrame: The care period for each patient (approx. 3 weeks up to 1 year)
measure: Positive predictive value of referral
timeFrame: The care period for each patient (approx. 3 weeks up to 1 year)
measure: Number of appointments needed for diagnostic clarification
timeFrame: The care period for each patient (approx. 3 weeks up to 1 year)
Other outcomes:
Locations:
city: Harstad
country: Norway
facility: Medical department - University Hospital of North Norway Harstad
Study officials:
affiliation: University Hospital of North Norway
name: Ann Ragnhild Broderstad, Dr. med
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.
citation: 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.
citation: 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.
citation: 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.