Adolescent idiopathic scoliosis (AIS) is a relatively common reason for referral to orthopedic surgery, but most referred patients do not require bracing or surgery. We developed a quality improvement (QI) program within the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, to reduce unnecessary specialty referrals for AIS.
The QI program consisted of physician education, decision support tools available at the point of care, and longitudinal feedback of data on physician referrals for AIS. Referral patterns in the 2-year postintervention period were tracked and compared with those of the 2-year preintervention period. Clinical characteristics of referred patients were compared through claims analysis and chart review.
Initial visits to orthopedic surgery for AIS declined from 5.1 to 4.1 per 1000 adolescents per year, a reduction of 20.4% (P = .01). Process control chart analysis showed a rapid change in referral patterns after the initiation of the program which was sustained over the 2-year postintervention period and demonstrated that 66 initial and 131 total AIS specialty visits were avoided as a result of the program.
A QI program consisting of physician education, decision support available at the point of care, and longitudinal data feedback led to a sustained reduction in unnecessary referrals for AIS. This program can serve as a model for other programs that seek to shift the locus of care from specialists to primary care providers.
[Show abstract][Hide abstract] ABSTRACT: Background
The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument.
We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson’s correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach’s alpha coefficient; the intraclass (ICC) and Pearson’s correlation coefficients were used for test-retest reliability.
One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson’s correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson’s correlation coefficient was 0.89 and ICC was 0.90.
The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality.
BMC Health Services Research 01/2013; 13(1):24. DOI:10.1186/1472-6963-13-24 · 1.71 Impact Factor
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