@article {635811,
	title = {Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance},
	journal = {Acad Pediatr},
	volume = {18},
	number = {4},
	year = {2018},
	pages = {409-417},
	abstract = {OBJECTIVE:One barrier to timely access to outpatient\&nbsp;pediatric\&nbsp;subspecialty\&nbsp;care is the complexity of scheduling processes. We evaluated the\&nbsp;impact\&nbsp;of implementing\&nbsp;electronically\&nbsp;transmitted\&nbsp;referrals\&nbsp;on\&nbsp;subspecialty\&nbsp;visit\&nbsp;attendance.METHODS:Through collaboration with stakeholders, an\&nbsp;electronically\&nbsp;transmitted\&nbsp;referral order system was designed, piloted, and implemented in 15 general pediatrics practices, with 24 additional practices serving as controls. We used statistical process control methods and difference-in-differences analysis to examine visits attended, appointments scheduled, appointment nonattendance, and referral volume.\&nbsp;Electronically\&nbsp;transmitted\&nbsp;referrals\&nbsp;then were expanded to all 39 practices. We surveyed referring pediatricians at all practices before and after\&nbsp;implementation.RESULTS:From April 2015 through September 2016 there were 33,485 referral orders across all practices (7770 before the pilot, 11,776 during the pilot, 13,939 after full\&nbsp;implementation). At pilot practices, there was a significant and sustained improvement in\&nbsp;subspecialty\&nbsp;visits attended within 4 weeks of referral (10.9\% to 20.0\%; P \&lt; .001). Relative to control practices, pilot practices experienced an 8.6\% improvement (P = .001). After\&nbsp;implementation\&nbsp;at control practices, rates of visits attended also improved but to a smaller degree: 11.8\% to 14.7\% (P \&lt; .001). In survey responses, referring pediatricians noted improved scheduling processes but had continued concerns with appointment availability and referral tracking.CONCLUSIONS:While\&nbsp;electronically\&nbsp;transmitted\&nbsp;referrals\&nbsp;improved\&nbsp;visit\&nbsp;attendance\&nbsp;after\&nbsp;pediatric\&nbsp;subspecialty\&nbsp;referral, the sizable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to\&nbsp;pediatric\&nbsp;subspecialty\&nbsp;care.Copyright {\textcopyright} 2018 Academic\&nbsp;Pediatric\&nbsp;Association. Published by Elsevier Inc. All rights reserved.},
	author = {Ray KN and Drnach M and Mehrotra A and Suresh S and Docimo SG}
}
