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Rev Med Inst Mex Seguro Soc. 2019 May 2;57(3):140-148.

General surgery referral´s outcomes and solution time

[Article in Spanish; Abstract available in Spanish from the publisher]

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Instituto Mexicano del Seguro Social, Hospital de Pediatría, Unidad de Investigación en Epidemiología Clínica. Ciudad de México, México


in English, Spanish


There are a variety of instruments and indicators to assess continuity of care; however there is a lack of those that describe the result of coordination between the health care levels.


To show two indicators that summarizes the result of the complete circuit primary level-secondary level-primary level.


An observational prospective cohort study was conducted, with a one-year follow-up of a random sample of the references to general surgery services in a family medicine unit of the IMSS. Two indicators were analyzed: the outcome of the reference to general surgery, categorized as resolved, withdrawal and not resolved; and the time of solution of the surgical problem, which measures the median in calendar days from the issuance of the reference to the counter-reference for the reason of original sending. The indicators were compared by characteristics of the patient and the first level physician.


The 84.8% of cases were resolved in a median time of 72 days (50-112), 14.1% of patients reject surgery and 1% wasn´t resolved. No statistically significant differences were found according the evaluated characteristics.


The overall solution time of the surgical problem in the medical unit is within the range built with previous studies, but in specific diagnoses there are significant variations. The frequency of solution of the surgical problem was high for diagnoses of greater risk.


Continuity of Patient Care; Health Care Levels; Transitional Care; General Surgery


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