First quality score for referral letters in gastroenterology-a validation study

BMJ Open. 2016 Oct 8;6(10):e012835. doi: 10.1136/bmjopen-2016-012835.

Abstract

Objective: To create and validate an objective and reliable score to assess referral quality in gastroenterology.

Design: An observational multicentre study.

Setting and participants: 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist.

Main outcome measure: Correlation between the TPS and a visual analogue scale (VAS) for referral quality.

Results: The 327 referrals had an average TPS of 13.2 (range 1-25) and an average VAS of 4.7 (range 0.2-9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good.

Conclusions: The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality.

Keywords: PRIMARY CARE.

Publication types

  • Multicenter Study
  • Observational Study
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Checklist
  • Child
  • Female
  • Gastroenterology*
  • Gastrointestinal Diseases / diagnosis*
  • Humans
  • Male
  • Middle Aged
  • Norway
  • Referral and Consultation*
  • Reproducibility of Results
  • Severity of Illness Index
  • Weight Loss
  • Young Adult