Statement of problem:
To look at the impact of a web based diagnosis checklist system (Isabel) on referrals for specialist care in a UK primary care setting. It is generally estimated that 30-50% of such referrals are inappropriate leading to inefficient use of specialist resources and delays in patient care.
Description of the intervention or program:
25 general practitioners (GPs) from 4 GP surgeries in southwest London used the Isabel system over a period of 6 months during 2010. The GPs used Isabel to enter patient clinical features in free text and were provided with a set of up to 20 diagnostic possibilities as a checklist for consideration. A voluntary web based survey form was added at the end of the consultation to collect information regarding users’ views on the diagnostic advice provided. The form contained 4 questions covering the impact of Isabel on their differential, referral and management.
Findings to date:
Over a 6-month period GPs entered 335 queries into the Isabel system. 49 survey’s were completed. In 47% of cases Isabel helped confirm the GPs’ differential and in 36% it broadened their differential. In 29% of cases they no longer needed to either refer a patient to a specialist or use the consultant advice line. In 36% of cases it helped them refer the patient more appropriately. In 40% of cases they ordered an additional test, in 4% of cases they ordered a medication, in 6% of cases they cancelled a medication and in 2% they cancelled a diagnostic test. Over the period of the pilot the average monthly number of referrals made by the practices fell by 15%.
Lessons learned:
These preliminary results show that a diagnosis checklist system, such as Isabel, could be a useful tool to improve the appropriateness of referrals from primary care to hospital-based specialists. This is especially relevant since a number of other strategies in this area,such as referral management centres, have failed to show significant effects.
See more of: The 32nd Annual Meeting of the Society for Medical Decision Making