Browsing by Subject "referrals"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Cognitive requirements for primary care providers during the referral process: Information needed from and interactions with an electronic health record system
    (Elsevier, 2019-09) Savoy, April; Militello, Laura; Diiulio, Julie; Midboe, Amanda M.; Weiner, Michael; Abbaszadegan, Hamed; Herout, Jennifer; Computer and Information Science, School of Science
    Objectives This study sought to identify and describe the cognitive requirements and associated information needs of referring primary care providers (PCPs) during the referral process as well as characterize referring PCPs’ experiences with current health information technology. Materials and methods We interviewed 62 referring PCPs. Our four-member analysis team used hierarchical task analysis to construct a goal-directed hierarchy. We utilized extensions of the task analysis to describe PCPs’ common experiences with health information technologies throughout the referral process. Results The resultant goal hierarchy includes one main goal (Referral for Additional Care), two sub-goals (Assess Patient’s Condition and Manage Referrals), and four major tasks with respective decisions (What consultation is warranted; What information should I provide; What additional action is needed; and How to integrate specialists’ findings). Approximately 22 information needs were commonly identified and PCPs described their use of various sources - other PCPs, electronic health records, chat software, and paper- to satisfy those information needs. Conclusion Cognitive demand for referring PCPs is high throughout the referral process. They have to search, identify, compose, track, and integrate information across multiple screens, systems, and people. Existing interfaces do not adequately support the communication, information exchange, or care coordination related to the referral process. Results from this study provide an important foundation for developing patient-centered displays that support PCPs’ decision-making process and reduce cognitive challenges.
  • Thumbnail Image
    Item
    Referral Patterns in Neuro-Ophthalmology
    (Wolters Kluwer, 2020-12) Stunkel, Leanne; Mackay, Devin D.; Bruce, Beau B.; Newman, Nancy J.; Biousse, Valérie; Neurology, School of Medicine
    Background: Neuro-ophthalmologists specialize in complex, urgent, vision- and life-threatening problems, diagnostic dilemmas, and management of complex work-ups. Access is currently limited by the relatively small number of neuro-ophthalmologists, and consequently, patients may be affected by incorrect or delayed diagnosis. The objective of this study is to analyze referral patterns to neuro-ophthalmologists, characterize rates of misdiagnoses and delayed diagnoses in patients ultimately referred, and delineate outcomes after neuro-ophthalmologic evaluation. Methods: Retrospective chart review of 300 new patients seen over 45 randomly chosen days between June 2011 and June 2015 in one tertiary care neuro-ophthalmology clinic. Demographics, distance traveled, time between onset and neuro-ophthalmology consultation (NOC), time between appointment request and NOC, number and types of providers seen before referral, unnecessary tests before referral, referral diagnoses, final diagnoses, and impact of the NOC on outcome were collected. Results: Patients traveled a median of 36.5 miles (interquartile range [IQR]: 20–85). Median time from symptom onset was 210 days (IQR: 70–1,100). Median time from referral to NOC was 34 days (IQR: 7–86), with peaks at one week (urgent requests) and 13 weeks (routine requests). Median number of previous providers seen was 2 (IQR: 2–4; range:0–10), and 102 patients (34%) had seen multiple providers within the same specialty before referral. Patients were most commonly referred for NOC by ophthalmologists (41% of referrals). Eighty-one percent (242/300) of referrals to neuro-ophthalmology were appropriate referrals. Of the 300 patients referred, 247 (82%) were complex or very complex; 119 (40%) were misdiagnosed; 147 (49%) were at least partially misdiagnosed; and 22 (7%) had unknown diagnoses. Women were more likely to be at least partially misdiagnosed—108 of 188 (57%) vs 39 of 112 (35%) of men (P < 0.001). Mismanagement or delay in care occurred in 85 (28%), unnecessary tests in 56 (19%), unnecessary consultations in 64 (22%), and imaging misinterpretation in 16 (5%). Neuro-ophthalmologists played a major role in directing treatment, such as preserving vision, preventing life-threatening complications, or avoiding harmful treatment in 62 (21%) patients. Conclusions: Most referrals to neuro-ophthalmologists are appropriate, but many are delayed. Misdiagnosis before referral is common. Neuro-ophthalmologists often prevent vision- and life-threatening complications.