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Referral System (referral + system)
Selected AbstractsEstablishing a Case-Finding and Referral System for At-Risk Older Individuals in the Emergency Department Setting: The SIGNET ModelJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2001Lorraine C. Mion PhD Older emergency department (ED) patients have complex medical, social, and physical problems. We established a program at four ED sites to improve case finding of at-risk older adults and provide comprehensive assessment in the ED setting with formal linkage to community agencies. The objectives of the program are to (1) improve case finding of at-risk older ED patients, (2) improve care planning and referral for those returning home, and (3) create a coordinated network of existing medical and community services. The four sites are a 1,000-bed teaching center, a 700-bed county teaching hospital, a 400-bed community hospital, and a health maintenance organization (HMO) ED site. Ten community agencies also participated in the study: four agencies associated with the hospital/HMO sites, two nonprofit private agencies, and four public agencies. Case finding is done using a simple screening assessment completed by the primary or triage nurse. A geriatric clinical nurse specialist (GCNS) further assesses those considered at risk. Patients with unmet medical, social, or health needs are referred to their primary physicians or to outpatient geriatric evaluation and management centers and to community agencies. After 18 months, the program has been successfully implemented at all four sites. Primary nurses screened over 70% (n = 28,437) of all older ED patients, GCNSs conducted 3,757 comprehensive assessments, participating agency referrals increased sixfold, and few patients refused the GCNS assessment or subsequent referral services. Thus, case finding and community linkage programs for at-risk older adults are feasible in the ED setting. [source] Follow-up to a Federally Qualified Health Center and Subsequent Emergency Department UtilizationACADEMIC EMERGENCY MEDICINE, Issue 1 2010Tara M. Scherer MD Abstract Objectives:, Determine if 1) proximity of referral to a federally qualified health center (FQHC) improves initial follow-up rates for discharged emergency patients, 2) improved initial follow-up rates are associated with improved rates for an "ongoing relationship" with the FQHC, and 3) an ongoing relationship with an FQHC is associated with decreased subsequent emergency department (ED) utilization over a 2-year follow-up period. Methods:, An expedited referral system was initiated just prior to January 2004 for discharged ED patients referred to an FQHC. Referral categories were as follows: R1 = next-day; R2 = 2 to 7 days; R3 = 2 to 3 weeks; and R4 = follow-up as needed. The FQHC database for 2004,2006 was merged with the ED database from 2004 through 2006. The FQHC database contained all ED referrals, the referral category, whether the patient kept his or her initial ED referral appointment, all subsequent scheduled clinic appointments, and whether the patient kept any of the subsequent scheduled appointments. We compared initial referral follow-up rates and subsequent scheduled visits to the FQHC for each referral category, over a 2-year follow-up period. We evaluated the effects of age, sex, marital status, insurance status, initial triage score, race, comorbidities, and number of prescription medications on initial follow-up, and subsequent kept appointments with the FQHC. We defined an "ongoing relationship" as one or more kept scheduled appointments annually. Finally, we compared the number of subsequent ED visits over the follow-up period between patients who maintained an ongoing relationship with the FQHC and those who did not, before and after correcting for the demographic and clinical factors. Results:, There were 520 referrals over the study period. Follow-up rates ranged from 37.5% (95% confidence interval [CI] = 13.5% to 69.6%) for R1 to 9.0% (95% CI = 4.4% to 17.0%) for R4. The overall ongoing relationship rate was 7.1% (95% CI = 5.2% to 9.7%) and had weak association with temporal proximity of referral. On bivariate analysis, older age, female sex, white race, one or more comorbidities, and three or more medications were associated with increased rates of initial follow-up. These factors (with the exception of race) were also associated with increased rates of developing an ongoing relationship. Patients with an ongoing relationship with the FQHC had more repeat ED visits over the study period than did patients without (3.6 vs. 1.7, p = 0.003). However, this difference was no longer evident after adjusting for age, race, comorbidities, and medication usage. Conclusions:, Overall patient follow-up to an FQHC was low, but increased with next-day or same-week referral. The ongoing relationship rate was low, but increased with temporal proximity of ED referral. Increased comorbidities and medication usage were significantly associated with increased initial follow-up rates, development of an ongoing relationship, and subsequent ED utilization. Patients with an ongoing relationship with the FQHC had higher ED utilization over the 2-year follow-up period, likely due to a higher rate of comorbidities. ACADEMIC EMERGENCY MEDICINE 2010; 17:55,62 © 2010 by the Society for Academic Emergency Medicine [source] Philip Corboy and the Construction of the Plaintiffs' Personal Injury BarLAW & SOCIAL INQUIRY, Issue 2 2005Sara Parikh Drawing on the career of Philip Corboy, this article examines the construction of the plaintiffs' personal injury bar in the second half of the 20th century. Through a relational biography based on Mr. Corboy's career, we look at the development of this subprofession in the context of the sociopolitical environment within which Mr. Corboy and his peers operated, the social capital they possessed, and the particular strategies they used as they worked to establish both a professional and market niche. This analysis shows how and why Mr. Corboy and his peers constructed a thriving subprofession that is characterized by a unique blend of working-class ideology, trial craft, professional bar leadership, Democratic politics, local philanthropy, and a market referral system,all of which reinforce the dominance and prestige of its own elite. [source] Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital birthsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2009A De Jonge Objective, To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. Design, A nationwide cohort study. Setting, The entire Netherlands. Population, A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown. Methods, Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. Main outcome measures, Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit. Results, No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16). Conclusions, This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system. [source] Inter general practice variability in use of referral guidelines for colorectal cancerCOLORECTAL DISEASE, Issue 8 2007S. K. P. John Abstract Objective, The Two-Week Wait (TWW) referral system for suspected colorectal cancers has a low yield. To examine this, we assessed the referral pattern of general practices within four primary care trusts and looked at the variability of yield of colorectal cancer amongst all TWW referrals and assessed the reasons for variability. Method, A prospectively collected database of all colorectal cancers was examined for new cases diagnosed in the 12 months from April 1st 2004. Patients were cross-referenced via general practitioner (GP) codes to identify the referral origin. Reasons for the variability in referral patterns from each general practice were assessed in relation to TWW referrals, population demographics and through postal questionnaire of GPs. Results, A total of 175 patients diagnosed with colorectal cancer were referred from 49 general practices. Whilst there was a positive correlation between the number of TWW referrals and colorectal cancer per 1000-practice population (P = 0.001; Spearman correlation coefficient rs=0.447, two-tailed), there was a big discrepancy between referrals and cancer diagnosed in many general practices. Twenty-six general practices (53%) had no colorectal cancer diagnosed via the TWW route and these practices had significantly lower utilization of the TWW referral pathway. In the postal survey, 22% of GPs were unaware of TWW clinics or colorectal cancer referral guidelines and only 8% of GPs knew the number of referral criteria. Conclusion, This study demonstrates wide variability within primary care, in the appropriate use of colorectal cancer referral guidelines. General practices should be targeted for education. [source] Investigating the nature of formal social support provision for young mothers in a city in the North West of EnglandHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2006Angela McLeod BA (Hons) MPH Abstract Young mothers often require support to remain socially ,included' after becoming pregnant and this, in its turn, could protect their health. In this context, new policy initiatives aimed at tackling social exclusion, such as those implemented under the National Teenage Pregnancy Strategy, could be working to build social support mechanisms. The present paper addresses the issue of whether statutory services do in fact deliver ,social inclusion', through the provision of appropriate social support for young mothers. Data are drawn from semistructured interviews with service providers from a variety of different settings. The questionnaire was structured around an established model of social support, developed by M. Barrera, called the Inventory of Socially Supportive Behaviours. The study took place in a deprived inner city in North West England. Eleven participants were interviewed from seven separate organisations. The findings indicate that there were well-developed referral systems between services, with services adopting a social model of health. Much informational and emotional support was provided. What was less clear is how services are enabling social support to be developed amongst peer groups accessing the services particularly at community level. It is questionable to what extent services are able to foster the development of social support through social activities and support groups, and even whether it is appropriate to expect them to do so. In some sense, services go some way to delivering social inclusion, in that they are providing advice about income, housing and other opportunities. However, services appear to be missing an opportunity to foster social inclusion through the lack of development of supportive networks amongst groups of peers, which may have implications for the health of young mothers. [source] Concordance with community mental health appointments: service users' reasons for discontinuationJOURNAL OF CLINICAL NURSING, Issue 7 2004Tony Hostick MSc Background., Quality issues are being given renewed emphasis through clinical governance and a drive to ensure service users' views underpin health service development. Aims., To establish service users' reasons for discontinuation of community based mental health appointments in one National Health Service Trust. Method., A two-phase survey of all non-completers over a year. Phase one using a structured postal questionnaire. Phase two using structured interviews with respondents to phase one by post, telephone and face to face. Results., A total of 243 discharges because of non-completion were identified by local services over the 12 months of the study and followed up by initial questionnaire. This represents 8.19% of all discharges (2967) within the same period. Forty-four users were engaged and followed up within phase two of the survey. Data were subject to both quantitative and qualitative analysis. Conclusions., Analysis of responses suggests that the main reasons for non-completion are because of dissatisfaction although the reasons are varied and the interplay between variables is complex. Whilst this user group are not apparently suffering from ,severe mental illness', there is clear, expressed need for a service. Relevance to clinical practice., Whoever provides such a service should be responsive to expressed need and a non-medical approach seems to be favoured. If these needs are appropriately met then users are more likely to be engaged and satisfaction is likely to be improved. Although this in itself does not necessarily mean improved clinical outcomes, users are more likely to stay in touch until an agreed discharge. Practical problems of applied health service research are discussed and recommendations are made for a review of referral systems, service delivery and organization with suggestions for further research. [source] | ||||||||||