Table 1 Metric Domains, Sub-domains, and Exemplary Metrics
From: Performance measures of the specialty referral process: a systematic review of the literature
Domain | Sub-domains | # Metrics | Metric Example |
|---|---|---|---|
Evaluation of Need for Specialty Care (n = 14) | Referral Source | 14 | Proportion of self-referred visits [38] |
| Â | Referral Decision | 0 | Â |
Referral Initiation (n = 73) | Reason for referral | 4 | Proportion of referrals for advice on diagnosis and treatment [3] |
| Â | Specialist selection | 27 | Proportion of PCPs who referred at patient request [39] |
| Â | Referral rate | 42 | # Referrals to a specialist per 100 PCP visits [40] |
Entry into Specialty Care (n = 53) | Attendance | 7 | Proportion of referred patients who attended first specialty visit [41] |
| Â | Accessibility | 46 | Total # providers per 100,000 people per state [42] |
Coordination (n = 60) | Communication | 48 | Proportion of specialist reports by letter or e-mail [43] |
| Â | Integration of care | 17 | Proportion of PCPs who received feedback from a specialist [43] |
Referral Type (n = 3) | Consultation | 3 | Proportion of referrals for procedural consultation [44] |
| Â | Co-management | 3 | Proportion of referrals for co-management with shared care [44] |
Clinical Tasks (n = 19) | Problem recognition | 10 | Proportion of letters including a patient's condition [45] |
| Â | Diagnosis | 18 | Proportion of letters including a patient's diagnosis [45] |
| Â | Treatment | 17 | Proportion of letters including treatment recommendation [45] |
| Â | Reassessment | 12 | Proportion of letters including follow-up arrangements [45] |
Resource Use (n = 13) | Services | 12 | Primary and specialty visits per patient per 30 days [46] |
| Â | Costs | 13 | Total annual specialty expenditures [47] |
Quality (n = 57) | Appropriateness | 13 | Proportion of patients who received an unnecessary referral [48] |
| Â | Effectiveness | 4 | Proportion of PCPs who adhered to a specialists' recommendations [49] |
| Â | Efficiency | 1 | Proportion of PCPs who believed a specialist was minimizing costs [50] |
| Â | Equity | 0 | Â |
| Â | Patient-centeredness | 8 | Proportion of patients who thought that specialty care was helpful[51] |
| Â | Referral satisfaction | 21 | Proportion of patients who were satisfied with specialty care [52] |
| Â | Safety | 0 | Â |
| Â | Timeliness | 23 | Average length of time spent for a specialty visit [53] |
Outcomes (n = 9) | Health status | 3 | Change in depression score on Hopkins Symptom Checklist [54] |
| Â | Mortality | 2 | Proportion of surviving patients per year [55] |
| Â | Functional status | 3 | Change in score on Pain Interference Scale [56] |
| Â | Unintended Consequences | 0 | Â |