BACKGROUND: To determine the referral rate (RR) per centre, its main causes and the adjusted efficiency indexes, through the retrospective implementation of the Adjusted Clinical Groups (ACG) in a Spanish primary care setting. METHODS: Design descriptive-retrospective study. Attended patients by five primary care teams (PCT) during the year 2004 were included. General parameters, age, gender, dependent (visits and episodes), and comorbidity of each patient relative to each ACG are used as measures. The RR was defined as the quotient between the number of referrals and the visits made. Efficiency Index (EI) was established dividing the observed by the expected referrals obtained by indirect standardization. Statistical significance P<0.05. RESULTS: Studied patients 81,335 (use: 76.9%), 5.0+/-3.6 episodes and 7.9+/-7.8 visits/patient/year. Percentage of visits with a referral, adjusted for morbidity burden, was 7.5% (CI: 7.3-7.7); age: 48.3+/-22.7 years (women: 55.9%), P=0.000. The average of referrals was of 59.6 per 100 attended patients/year (P=0.000). Visits and episodes explain 34.1-68.1%, respectively (P=0.000), the explanatory power of the classification's variability was of 23.6% (P=0.0001). EI per centre were: 0.95 (CI: 0.82-1.08); 0.78 (CI: 0.63-0.93); 0.88 (CI: 0.73-1.03); 1.15 (CI: 1.03-1.27) and 1.08 (CI: 0.95-1.21), P=0.034 (family practice); and 0.83 (CI: 0.70-0.96); 0.83 (CI: 0.68-0.98); 0.84 (CI: 0.70-0.98); 1.24 (CI: 1.12-1.36) and 1.16 (CI: 1.03-1.29), P=0.041 (paediatrics), respectively. CONCLUSIONS: Adjusted morbidity by ACG explains an important part of the referrals variability. The study results must be interpreted cautiously even after adjustment by age, gender and morbidity. Should the results be confirmed, it would allow an improvement in the measurement of referrals for clinical management in the PCT.
BACKGROUND: To determine the referral rate (RR) per centre, its main causes and the adjusted efficiency indexes, through the retrospective implementation of the Adjusted Clinical Groups (ACG) in a Spanish primary care setting. METHODS: Design descriptive-retrospective study. Attended patients by five primary care teams (PCT) during the year 2004 were included. General parameters, age, gender, dependent (visits and episodes), and comorbidity of each patient relative to each ACG are used as measures. The RR was defined as the quotient between the number of referrals and the visits made. Efficiency Index (EI) was established dividing the observed by the expected referrals obtained by indirect standardization. Statistical significance P<0.05. RESULTS: Studied patients 81,335 (use: 76.9%), 5.0+/-3.6 episodes and 7.9+/-7.8 visits/patient/year. Percentage of visits with a referral, adjusted for morbidity burden, was 7.5% (CI: 7.3-7.7); age: 48.3+/-22.7 years (women: 55.9%), P=0.000. The average of referrals was of 59.6 per 100 attended patients/year (P=0.000). Visits and episodes explain 34.1-68.1%, respectively (P=0.000), the explanatory power of the classification's variability was of 23.6% (P=0.0001). EI per centre were: 0.95 (CI: 0.82-1.08); 0.78 (CI: 0.63-0.93); 0.88 (CI: 0.73-1.03); 1.15 (CI: 1.03-1.27) and 1.08 (CI: 0.95-1.21), P=0.034 (family practice); and 0.83 (CI: 0.70-0.96); 0.83 (CI: 0.68-0.98); 0.84 (CI: 0.70-0.98); 1.24 (CI: 1.12-1.36) and 1.16 (CI: 1.03-1.29), P=0.041 (paediatrics), respectively. CONCLUSIONS: Adjusted morbidity by ACG explains an important part of the referrals variability. The study results must be interpreted cautiously even after adjustment by age, gender and morbidity. Should the results be confirmed, it would allow an improvement in the measurement of referrals for clinical management in the PCT.
Authors: Jose M Valderas; Barbara Starfield; Christopher B Forrest; Bonnie Sibbald; Martin Roland Journal: Ann Fam Med Date: 2009 Mar-Apr Impact factor: 5.166
Authors: Maria Consuelo Company-Sancho; Víctor M González-Chordá; María Isabel Orts-Cortés Journal: Int J Environ Res Public Health Date: 2022-04-01 Impact factor: 3.390
Authors: Shelley-Ann M Girwar; Robert Jabroer; Marta Fiocco; Stephen P Sutch; Mattijs E Numans; Marc A Bruijnzeels Journal: Health Sci Rep Date: 2021-07-23