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BMJ Open. 2016 Oct 8;6(10):e012835. doi: 10.1136/bmjopen-2016-012835.

First quality score for referral letters in gastroenterology-a validation study.

Author information

1
Department of Medical Research, Vestre Viken Hospital Trust Bærum, Drammen, Norway.
2
Research Support Services, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
3
Department of Medicine, Vestfold Hospital Trust Tønsberg, Tønsberg, Norway.
4
Department of Medicine, Vestre Viken Hospital Trust Bærum, Drammen, Norway.
5
Department of Gastroenterology, Innlandet Hospital Trust Gjøvik, Gjøvik, Norway.
6
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
7
Department of Gastroenterology, Østfold Hospital Kalnes, Kalnes, Norway.
8
Department of Medicine, Innlandet Hospital Trust Lillehammer, Lillehammer, Norway.
9
Department of Gastroenterology, Telemark Hospital Trust Skien, Skien, Norway.
10
Department of Medicine, Vestre Viken Hospital Trust Drammen, Drammen, Norway.
11
Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
12
Department of Health Economics and Health Management, University of Oslo, Oslo, Norway.
13
Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
14
Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway.

Abstract

OBJECTIVE:

To create and validate an objective and reliable score to assess referral quality in gastroenterology.

DESIGN:

An observational multicentre study.

SETTING AND PARTICIPANTS:

25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist.

MAIN OUTCOME MEASURE:

Correlation between the TPS and a visual analogue scale (VAS) for referral quality.

RESULTS:

The 327 referrals had an average TPS of 13.2 (range 1-25) and an average VAS of 4.7 (range 0.2-9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good.

CONCLUSIONS:

The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality.

KEYWORDS:

PRIMARY CARE

PMID:
27855107
PMCID:
PMC5073635
DOI:
10.1136/bmjopen-2016-012835
[Indexed for MEDLINE]
Free PMC Article

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