PMID- 8685304
OWN - NLM
STAT- MEDLINE
DCOM- 19960816
LR  - 20190909
IS  - 0033-3506 (Print)
IS  - 0033-3506 (Linking)
VI  - 110
IP  - 1
DP  - 1996 Jan
TI  - An "early warning system' for health needs: surveillance of the quality of 
      clinical services by audit of extra-contractual referrals (ECRs).
PG  - 21-3
AB  - Extra-contractual referrals (ECRs) can be a cause of considerable anxiety to 
      purchasing authorities, mainly because of their potential to generate unexpected 
      expenditure. But ECRs can also be used as a tool for monitoring the demand for, 
      and quality of, clinical services. ECRs were studied in the Darlington Health 
      Authority district using a variety of methods including inter-disciplinary 
      meetings, a series of interviews with local GPs, and a questionnaire to general 
      practitioners on 230 consecutive ECRs. The methods and results of the 
      questionnaire study are presented. The commonest reasons for making ECRs included 
      the mistaken belief that a contract existed with the ECR provider, patient 
      dissatisfaction with the local provider, and referral to benefit from shorter 
      waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and 
      throat services were over-represented. Questionnaire results were validated by 
      comparison with an interview study of all GPs in the district. We conclude that 
      trends in ECRs can be monitored as a convenient "early warning system' to alert 
      purchasing authorities to changes in demand or perceived problems with local 
      provider units. ECR data must be interpreted in the context of further local 
      background information from sources such as GPs and public health physicians. In 
      the case of Darlington, scrutiny of ECRs has led to changes in services and 
      contracts.
FAU - Charlton, B G
AU  - Charlton BG
AD  - County Durham Health Commission, Durham.
FAU - Michie, A F
AU  - Michie AF
FAU - Gorton, R K
AU  - Gorton RK
FAU - Pugh, E
AU  - Pugh E
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Public Health
JT  - Public health
JID - 0376507
SB  - IM
MH  - Contract Services/*statistics & numerical data
MH  - England
MH  - Family Practice/statistics & numerical data
MH  - Health Services Needs and Demand/*trends
MH  - Humans
MH  - Medical Audit/*statistics & numerical data
MH  - Patient Care Team/statistics & numerical data
MH  - Referral and Consultation/*statistics & numerical data
MH  - State Medicine/*statistics & numerical data
EDAT- 1996/01/01 00:00
MHDA- 1996/01/01 00:01
CRDT- 1996/01/01 00:00
PHST- 1996/01/01 00:00 [pubmed]
PHST- 1996/01/01 00:01 [medline]
PHST- 1996/01/01 00:00 [entrez]
AID - S0033-3506(96)80030-8 [pii]
AID - 10.1016/s0033-3506(96)80030-8 [doi]
PST - ppublish
SO  - Public Health. 1996 Jan;110(1):21-3. doi: 10.1016/s0033-3506(96)80030-8.