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J Ambul Care Manage. 2018 May 15. doi: 10.1097/JAC.0000000000000247. [Epub ahead of print]

Closing the Referral Loop: Improving Ambulatory Referral Management, Electronic Health Record Connectivity, and Care Coordination Processes.

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PCPI, Chicago, Illinois (Mr Davidow); and The Wright Center for Graduate Medical Education, Scranton, Pennsylvania (Drs Sheth, Sixta, and Thomas-Hemak).


More than 105 million referrals of Medicare beneficiaries to specialists occur annually. Different settings and electronic health records have made care coordination complex. PCPI (formerly American Medical Association-convened Physicians Consortium for Performance Improvement) and The Wright Center for Graduate Medical Education sponsored the Closing the Referral Loop pilot project. Twelve dyads of primary care and specialist physicians sought to improve ambulatory referrals by mapping the referral process, and using care compacts, metrics, and electronic health records. Referrals closed on time increased from 40% to 70%. Clinical questions answered increased from 50% to 75%. Adoption of the change package and lessons from this project may significantly improve ambulatory referral management.

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