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

• ClinicalTrials.gov Identifier: NCT01470963
• Recruitment Status: Completed
• First Posted: November 11, 2011
• Last Update Posted: July 11, 2014
• Sponsor: University Hospital of North Norway
• Collaborator: University of Tromso
• Information provided by (Responsible Party): University Hospital of North Norway

Study Description

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.

Condition or disease	Intervention/treatment	Phase
Referral; Quality of Health Care	Other: Implementation of referral template	Not Applicable

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

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 500 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Health Services Research
• 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 Start Date: September 2011
• Actual Primary Completion Date: January 2014
• Actual Study Completion Date: January 2014

Arms and Interventions

Arm	Intervention/treatment
Experimental: Referral template; Implementation of the referral templates at the GP office	Other: Implementation of referral template; Implementation of referral template at the GP office
No Intervention: Control; Normal referral pattern

Outcome Measures

Primary Outcome Measures :

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 Outcome Measures :

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

   1. a diagnostic clarification, or
   2. a histological diagnosis, or
   3. 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

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

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

Contacts and Locations

Locations

Norway

Medical department - University Hospital of North Norway Harstad

Harstad, Norway, 9480

Sponsors and Collaborators

University Hospital of North Norway

University of Tromso

Investigators

• Principal Investigator: Ann Ragnhild Broderstad, Dr. med; University Hospital of North Norway

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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.

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.

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.

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.

• Responsible Party: University Hospital of North Norway
• ClinicalTrials.gov Identifier: NCT01470963
• Other Study ID Numbers: HST1026-11
• First Posted: November 11, 2011
• Last Update Posted: July 11, 2014
• Last Verified: July 2014

Keywords provided by University Hospital of North Norway:

Referral; Quality of Health Care