Official Title: Assessing Performance of the Specialty Referral System: Concepts and Metrics
Research Lead: James Guevara, M.D., M.P.H.
Study Team: Diane Hsu, Christopher Forrest, M.D., Ph.D.
Sponsored By: California HealthCare Foundation
Dates: January 2009 to December 2009
Background
High performing health systems allocate financial and human resources in ways that produce superior outcomes as efficiently as possible for the populations served. The fields of health economics and health services research have devoted considerable attention to identifying optimal strategies for efficiently and equitably distributing scarce healthcare resources. Less consideration has been given to efficient allocation and usage of health professionals, although there is a substantial literature on forecasting the number of physicians required to meet the demand and needs of the population. While there is empirical evidence regarding the role of primary care practitioners in the healthcare delivery system, the characteristics of high performing specialty care are not widely known, which partly stems from a lack of measures to assess the appropriateness, quality, and efficiency of specialty referrals.
Aims
- Develop a conceptual model for framing specialty referrals and linking to measures of health system performance and outcomes;
- Identify measures of specialty referral to assess the quality and efficiency of referral types and their effects in different systems of care;
- Validate the framework and measures among a pool of national experts
Methods
A systematic review of the literature for potential validated measures assessing the structure, processes, and outcomes of the specialty referral process relevant to the US healthcare system, and the construction of a conceptual model for specialty referrals that frames the typology was conducted. Upon completion of the literature review and content validation, we created a toolkit of measures assessing the performance of the specialty referral system using primary or secondary data sources and validated using a national panel of experts.
Progress
Data collection and analysis are complete. A toolkit of validated measures linked by the conceptual framework has been developed.
Policy Focus
- Measures of specialty care referral could be used to benchmark practices and assist providers in meeting standards and to assist healthcare delivery systems in determining the most rational ways to organize the primary-specialty care interface
- Validated measures could provide baseline measures for quality improvement activities of specialists
Dissemination
Hsu D, Guevara JP, Forrest CB. Measuring the Performance of the Specialty Referral Process: A Systematic Review of the Literature. Presented at the 2010 Annual Research Meeting, AcademyHealth, Boston, MA, June, 2010.
Guevara JP, Hsu D, Forrest CB. Measuring the Performance of the Pediatric Specialty Referral Process: A Systematic Review of the Literature. Paper under Review.
