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Technical Report - The Commonwealth Fund

Technical Report - The Commonwealth Fund

Exhibit 7. Implications

Exhibit 7. Implications of Data Availability and Access on Measure Implementation Measure Required Data Elements Key Implementation Findings All Measures (denominator) Measure 1 Critical Information Communicated with Request for Referral/Consult to Specialist (numerator) Measure 2 PCP Communicates to Patient the Reason for Referral (numerator) Measure 3 Specialist Report Sent to PCP (numerator) Measure 4 Specialist Communicates with Patient/Family (numerator) Measure 5 PCP Receipt and Review of Specialist Report (numerator) • age • patient referred (y/n) • referral source (self vs. PCP) • activity requested • reason for referral • preferred timing • problem list • medication list • medical history • reason for referral given to patient • name of specialist given to patient • time frame given to patient • specialist report received by PCP • specialist report received by patient • specialist report viewed by PCP SUMMARY OF KEY FINDINGS 16 • Age and referral event captured electronically at all EHR-based sites. • Referral source (self/PCP) not consistently captured in either paper or electronic practices. • Most elements available in chart of all or nearly all seven sites. • Data elements are often not sufficiently structured for electronic capture and reporting. • Elements may not be consistently recorded. • Many sites document data on reason for referral and name of specialist (or practice) given to patient. • None provided time frame for referral to patient. • Elements not consistently recorded or explicitly tracked. • Not evaluated in site visits. • Not evaluated in site visits. • Variety of paper and electronic strategies are used for this coordination step. • Manual abstraction will allow this action to be tracked in practices with paper-based or electronic records systems. • Element of PCP receipt and review of specialist report not operationally different from element for Measure 3 in EHR practices. • Clinically relevant and face valid measures of the referral coordination process can be developed and implemented using electronic health records. Our project developed and tested measures of referral coordination for clinical relevance and acceptability with practicing primary care providers. The final set of measures includes three specific to the primary care setting (see Exhibit 8 below) and two measures evaluating specialist care.

Eligible Population (denominator) Referral Loop Opened Patient Informed Referral Loop Closed Exhibit 8. Final Measure Set From the Primary Care Perspective From the Specialty Care Perspective Number of patients aged 18 and over who were sent to another clinician for referral or consultation. Exclusions: Patients who self-refer to a specialist. 1A. Critical Information Communicated with Request for Referral to Specialist (Sent by PCP) Number of patients in the denominator with relevant clinical information communicated using the Continuity of Care Document (HL7 CCD) with request for referral to specialist. Relevant clinical information is defined as: • activity requested (referral, consultation, comanagement); • clinical reason for requesting the referral/consultation; • preferred timing for completion of the referral/consultation; • problem list; • medication list; and • medical history, including relevant test results. 2. PCP Communicates to Patient the Reason for Referral Number of referred patients where primary care clinician gave patient written information on reason for referral/consultation. Information must include: • reason for need for specialist involvement; and • name and contact information for specialist. 5. PCP Receipt and Review of Specialist Report Number of referred patients seen by the specialist where the PCP reviewed the results of the specialist report. 17 Number of patients aged 18 and over who were referred to a specialist and seen by that clinician. Exclusions: Patients who self-refer to a specialist. 1B. Critical Information Communicated with Request for Referral to Specialist (Received by Specialist) Number of patients in the denominator with relevant clinical information communicated using the Continuity of Care Document (HL7 CCD) with request for referral to specialist. Relevant clinical information is defined as: • activity requested (referral, consultation, comanagement) • clinical reason for requesting the referral/consultation; • preferred timing for completion of the referral/consultation; • problem list; • medication list; and medical history, including relevant test results. 4. Specialist Communicates with Patient/Family Number of patients in the denominator seen by a specialist where the specialist provided written results to the patient. 3. Specialist Report Sent to PCP Physician Number of patients in the denominator where the specialist communicated results in a report to the PCP using the Continuity of Care Document (HL7 CCD). Elements of the report must include: • findings; and • treatment recommendations including degree of shared management of patient and roles for specialist and PCP. Exclusions: Patients in the eligible population who refuse to allow sharing of results with PCP.

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