A Web-based Generalist–Specialist System to Improve Scheduling of Outpatient Specialty Consultations in an Academic Center
Open accessAbstract
Background Failed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.Objective We determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.Design Staggered implementation of a quality-improvement project, with comparison of intervention and control groups.Participants Patients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.Interventions Faxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.Measurements We compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.Main results Among 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.Conclusions With a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a U.S. record review of 40,487 referrals, before a Web-based referral system, 54% of contacts resulted in a scheduled specialty visit, compared with 83% after the intervention.
“Before the intervention, 54% of contacts resulted in a scheduled specialty visit, compared with 83% after the intervention.”
From The Empirical Foundations of Telemedicine Interventions in Primary Care (2016) · cites this paper as [93]
In that U.S. record review, the median time to an appointment was 168 days before and 78 days after the intervention.
“The median time to an appointment was 168 days before and 78 days after the intervention.”
From The Empirical Foundations of Telemedicine Interventions in Primary Care (2016) · cites this paper as [93]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Wall, A. (2000) · British Journal of Healthcare Management · doi:10.12968/bjhc.2000.6.9.19311 · Cited by 5,909 · see citing works
To Err is Human: Building a Safer Health System in 1999.
Stefl, M. E. (2001) · PubMed · Cited by 1,738 · see citing works
Communication breakdown in the outpatient referral process
Gandhi, T. K., Sittig, D. F., Franklin, M., Sussman, A. J., Fairchild, D. G., & Bates, D. W. (2000) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2000.91119.x · Cited by 371 · see citing works
Coordination of Specialty Referrals and Physician Satisfaction With Referral Care
Forrest, C. B., Glade, G. B., Baker, A. E., et al. (2000) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.154.5.499 · Cited by 203 · see citing works
Cm, A. (1986) · JAMA · doi:10.1001/jama.255.19.2617 · Cited by 158 · see citing works
Influence of delay to diagnosis on prognostic indicators of screen‐detected breast carcinoma
Olivotto, I. A., Gomi, A., Bancej, C. M., Brisson, J., Tonita, J. M., Kan, L., Mah, Z., Harrison, M., & Shumak, R. S. (2002) · Cancer · doi:10.1002/cncr.10453 · Cited by 116 · see citing works
Explaining Variation in General Practitioner Referrals to Hospital
Wilkin, D., & SMITH, A. (1987) · Family Practice · doi:10.1093/fampra/4.3.160 · Cited by 106 · see citing works
Rosemann, T. J., Wensing, M., Rueter, G., et al. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-5 · Cited by 68 · see citing works
Variability in consultation rates and practitioner level of diagnostic certainty.
Ns, C., Rb, H., & Licht, W. E. (1992) · PubMed · Cited by 60 · see citing works
Shah, P. N., Maly, R. C., Frank, J. C., et al. (1997) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1997.tb05164.x · Cited by 43 · see citing works
Exploring the Generalist-Subspecialist Interface in Internal Medicine
Linzer, M., Myerburg, R. J., Kutner, J. S., Wilcox, C. M., Oddone, E. Ž., DeHoratius, R. J., & Naccarelli, G. V. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.03.007 · Cited by 38 · see citing works
Compliance with the recommendations of medical consultants
Ballard, W. P., Gold, J. P., & Charlson, M. E. (1986) · Journal of General Internal Medicine · doi:10.1007/bf02596186 · Cited by 33 · see citing works
Organizational aspects of e-referrals
Wootton, R., Harno, K., & Reponen, J. (2003) · Journal of Telemedicine and Telecare · doi:10.1258/135763303322596354 · Cited by 29 · see citing works
Abbott, K. C., Mann, S., DeWitt, D., Sales, L. Y., Kennedy, S. K., & Poropatich, R. K. (2002) · Military Medicine · doi:10.1093/milmed/167.3.200 · Cited by 29 · see citing works
Electronic Messaging Between Primary and Secondary Care: A Four-year Case Report
Moorman, P. W., Branger, P. J., van der Kam, W. J., et al. (2001) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2001.0080372 · Cited by 24 · see citing works
Mozumdar, B. C., Hornsby, D. N., Gogate, A., et al. (2003) · Academic Radiology · doi:10.1016/s1076-6332(03)00002-3 · Cited by 16 · see citing works
Adhering to inpatient geriatric consultation recommendations.
Cefalu, C. A. (1996) · PubMed · Cited by 14 · see citing works
Why bother with a computerized scheduling system?
Arenson, R. L. (1988) · Journal of Imaging Informatics in Medicine · doi:10.1007/bf03167747 · Cited by 5 · see citing works
QUERI II and VA Performance Improvement
Ordin, D. L. (2006) · PsycEXTRA Dataset · doi:10.1037/e578182006-002 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Mdege, N. D., Man, M.-S., Taylor (nee Brown), C. A., & Torgerson, D. J. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.12.003 · Cited by 425 · see citing works
The Empirical Foundations of Telemedicine Interventions in Primary Care
Bashshur, R. L., Howell, J. D., Krupinski, E. A., Harms, K. M., Bashshur, N., & Doarn, C. R. (2016) · Telemedicine and e-Health · doi:10.1089/tmj.2016.0045 · Cited by 370 · see citing works
Nguyen, A. M., Cleland, C. M., Dickinson, L. M., Barry, M. P., Cykert, S., Duffy, F. D., Kuzel, A. J., Lindner, S. R., Parchman, M. L., Shelley, D. R., et al. (2022) · The Annals of Family Medicine · doi:10.1370/afm.2810 · Cited by 23 · see citing works
- Authors
- Weiner, M., El Hoyek, G., Wang, L., Dexter, P. R., Zerr, A. D., Perkins, A. J., James, F., & Juneja, R.
- Affiliations
- Indiana University Indianapolis (US)
- Regenstrief Institute (US)
- Indiana University School of Medicine (US)
- Indiana University (US)
- Corresponding author
- Weiner, Michael
- Venue
- Journal of General Internal Medicine
- Published
- 2009-04-15
- Volume
- 24
- Issue
- 6
- Pages
- 710-715
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2686771
- OpenAlex
- W2072710891
- Semantic Scholar
- 32ae802e54dcc89fd19dd4244bbc4a425683d88b
- Cited by
- 36
- References
- 20
- Citations by year
- 2025: 1 · 2023: 4 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 3 · 2014: 3 · 2012: 5
- FWCI
- 6.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (K23AG020088)
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Keywords
- specialist referral, access to specialist care, academic medical centers, primary care referral, quality improvement
- MeSH terms
- Academic Medical Centers, Adult, Aged, Ambulatory Care, Appointments and Schedules, Female, Humans, Male, Medicine, Middle Aged, Outpatient Clinics, Hospital, Physicians, Family, Referral and Consultation, Internet, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
