Pre-appointment management of new patient referrals in rheumatology: a key strategy for improving health care delivery.

OBJECTIVE: To analyze the impact of a rheumatologist reviewing each newly referred patient's medical records prior to scheduling an appointment (pre-appointment management).
METHODS: All 279 new patients who were referred in the 6 months after initiating pre-appointment management were studied. The authors reviewed systemwide patient records, appointment intake information, visit schedules, physician comments, and patient complaint data.
RESULTS: Only 59% of referred patients required a rheumatology consultation for appropriate care. Some problems were rapidly resolved without consultation. In some cases, other specialty consultation or continuing prior care was considered to be more appropriate. The latter alternative did not compromise these patients' outcomes. Practice access and efficiency were improved. Profitability was maintained. Referring physicians and patients were generally accepting and cooperative.
CONCLUSION: New patient pre-appointment management should be a key strategy for reducing health care costs, addressing personnel shortage, and improving access to and coordination of rheumatic disease care.