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Completed

NCT Number: NCT01470963

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

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.

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Key information

Conditions

Referral Quality of Health Care

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Medical department - University Hospital of North Norway Harstad

Harstad, 9480, Norway

About this study

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

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Implementation of referral template

Other

Implementation of referral template at the GP office

Primary outcomes

  1. Collated quality indicator score

    Time frame: The care period for each patient (approx. 3 weeks up to 1 year)

    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.

Secondary outcomes

  1. Improved referral quality

    Time frame: The care period for each patient (approx. 3 weeks up to 1 year)

    The investigators will evaluate each referral against the referral template, and then compare between intervention and control groups.

  2. Waiting time from referral to appointment

    Time frame: The care period for each patient (approx. 3 weeks up to 1 year)

  3. Time from referral to initiation of treatment

    Time frame: The care period for each patient (approx. 3 weeks up to 1 year)

    Compare the time from referral to initiation of treatment/"decision no treatment" necessary between intervention and control groups

  4. Percentage of patients seen within investigation deadline

    Time frame: Assessed at end of study - approx 2 years

    Compare the number of patients in the two groups seen within the limit set in national prioritisation guidelines

  5. Number of patients designated with investigation deadline

    Time frame: Assessed at end of study - approx 2 years

    Compare the number of patients in the intervention vs. control group that were designated with a investigation deadline according to national prioritisation guidelines

  6. Patient satisfaction

    Time frame: The care period for each patient (approx. 3 weeks up to 1 year)

    Patient satisfaction as measured by self report questionnaire

  7. Positive predictive value of referral

    Time frame: The care period for each patient (approx. 3 weeks up to 1 year)

    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

  8. Number of appointments needed for diagnostic clarification

    Time frame: The care period for each patient (approx. 3 weeks up to 1 year)

    Compare the number of appointments needed to clarify diagnosis between intervention and control groups

Sponsors and collaborators

Lead sponsor

University Hospital of North Norway

Other

Collaborators

  • University of Tromso

Registry information

Official study 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

Important dates

Study start
2011
Primary completion
2014
Study completion
2014
First posted
Nov 11, 2011
Registry last updated
Jul 11, 2014

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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