Evaluation of specialist referrals at a rural health care clinic

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Summit Pacific Medical Center (SPMC) is a rural critical access hospital system with an Emergency Department, 10 inpatient beds, and 3 primary care clinics located in Grays Harbor County, Washington. Like many healthcare systems, SPMC is evaluating strategies to transition to value‐based care while meeting the triple aim of reducing costs, improving population health, and enhancing patient experience (Bisognano & Kenney, 2012). Primary care is the core service of SPMC, but not all problems can be managed in primary care. Like many rural hospitals, SPMC does not have an established network of specialists and clinicians rely on referring patients outside the system of care. Our initial goal was to conduct a retrospective chart review to gain greater understanding of referral patterns for specialist care and quality. The plan was to use the data to create internal, evidence‐based referral protocols that would be cost effective, improve the health of our population, and provide a high quality experience for our patients.
No prior evaluation of specialist referrals from primary care has been conducted. An evaluation of this process was broadly aligned with the interests of administrative and clinical leadership, offering useful data for the transition to value‐based payments and the expansion of an on‐site Internal medicine service line.
These data resulted in surprising findings, changing the nature of the planned interventions. The data from the chart review enabled creation of two quality improvement projects: (a) a LEAN project to improve the referral process and (b) the creation and implementation of two referral protocols aimed at reducing unnecessary referrals. The application of these protocols was limited to orthopedic and neurosurgery referrals, as the data indicated a significant number could still be appropriately managed by the primary care provider. These interventions were of limited scope. Further research was conducted to investigate evidence‐based interventions and make recommendations for improving referrals on a larger scale.
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